Provider Demographics
NPI:1992294425
Name:FERDINAND, NANCIE (LAPC)
Entity type:Individual
Prefix:
First Name:NANCIE
Middle Name:
Last Name:FERDINAND
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1738 DANRICH DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-4819
Mailing Address - Country:US
Mailing Address - Phone:770-940-3201
Mailing Address - Fax:
Practice Address - Street 1:965 OAKLAND RD STE E
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-3758
Practice Address - Country:US
Practice Address - Phone:770-495-9775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005251101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health