Basic Information
| Provider Information | |||||||||
| NPI: | 1891148862 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERRELL | ||||||||
| FirstName: | ESTELLA | ||||||||
| MiddleName: | BERNIECE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSWA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | FERRELL | ||||||||
| OtherFirstName: | ESTELLA | ||||||||
| OtherMiddleName: | BERNIECE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5456 FOXWOOD DR NE | ||||||||
| Address2: | |||||||||
| City: | RIEGELWOOD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284569303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7408210542 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 411 COURT ST | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456623932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403546685 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2016 | ||||||||
| LastUpdateDate: | 10/31/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | ICDC131169 | OH | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 104100000X | S1502368 | OH | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | P011411 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.