Basic Information
| Provider Information | |||||||||
| NPI: | 1982042990 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERRELL | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | DIANE | ||||||||
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| Credential: | LCMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 5TH AVE E | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287924377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286968263 | ||||||||
| FaxNumber: | 8286961794 | ||||||||
| Practice Location | |||||||||
| Address1: | 321 WOLVERINE TRL | ||||||||
| Address2: | |||||||||
| City: | MILL SPRING | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287565821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282333712 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2013 | ||||||||
| LastUpdateDate: | 03/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | A9272 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.