Basic Information
| Provider Information | |||||||||
| NPI: | 1871860791 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FELDT | ||||||||
| FirstName: | WANDA | ||||||||
| MiddleName: | CHEATHAM | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | P-LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3395 NC HIGHWAY 24 27 | ||||||||
| Address2: | |||||||||
| City: | CAMERON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283268319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102457053 | ||||||||
| FaxNumber: | 9102459901 | ||||||||
| Practice Location | |||||||||
| Address1: | 280 PINEHURST AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTHERN PINES | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283876350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106926008 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2011 | ||||||||
| LastUpdateDate: | 01/03/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | P006720 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.