Provider Demographics
NPI:1174869887
Name:FEREBEE, JERMAINE SHANTA
Entity type:Individual
Prefix:
First Name:JERMAINE
Middle Name:SHANTA
Last Name:FEREBEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 GREENVILLE BLVD SE STE B1
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5758
Mailing Address - Country:US
Mailing Address - Phone:252-341-4192
Mailing Address - Fax:866-309-9297
Practice Address - Street 1:200 VALENCIA DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6311
Practice Address - Country:US
Practice Address - Phone:252-341-4192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-48283103K00000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist