Provider Demographics
NPI:1538337175
Name:FERNANDEZ, MARY (CPRP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ELBERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30635-1806
Mailing Address - Country:US
Mailing Address - Phone:706-549-3182
Mailing Address - Fax:706-213-2023
Practice Address - Street 1:250 NORTH AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-2244
Practice Address - Country:US
Practice Address - Phone:706-542-9700
Practice Address - Fax:706-227-7249
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor