Provider Demographics
NPI:1447345889
Name:FEUQUAY, LINDA JEAN (NCACI ICACII)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JEAN
Last Name:FEUQUAY
Suffix:
Gender:F
Credentials:NCACI ICACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5609 S. HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:WINAMAC
Mailing Address - State:IN
Mailing Address - Zip Code:46996
Mailing Address - Country:US
Mailing Address - Phone:574-595-7329
Mailing Address - Fax:
Practice Address - Street 1:207 N. BLUFF ST.
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960
Practice Address - Country:US
Practice Address - Phone:574-583-9350
Practice Address - Fax:574-583-7997
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18539101YA0400X
INA685R101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)