Provider Demographics
NPI:1265889513
Name:FERG, TINA FELICE (LPC, NCC, CPCS, CFRC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:FELICE
Last Name:FERG
Suffix:
Gender:F
Credentials:LPC, NCC, CPCS, CFRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 DAHLONEGA ST STE A101
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2481
Mailing Address - Country:US
Mailing Address - Phone:470-239-4119
Mailing Address - Fax:803-845-5008
Practice Address - Street 1:327 DAHLONEGA ST STE A101
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2481
Practice Address - Country:US
Practice Address - Phone:706-872-2985
Practice Address - Fax:470-239-4119
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009886101YM0800X
GAAPC004683101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC009886OtherGA PROFESSIONAL COUNSELOR LICENSE
SCLPC6936OtherSC PROFESSIONAL COUNSELOR LICENSE
GA003205680AMedicaid
GA14266875OtherCAQH