Provider Demographics
NPI:1144786476
Name:FERLIC, KYLE JOSEPH (LPCA)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:JOSEPH
Last Name:FERLIC
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 AVALON FOREST LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-8195
Mailing Address - Country:US
Mailing Address - Phone:803-792-1559
Mailing Address - Fax:
Practice Address - Street 1:20721 TORRENCE CHAPEL RD STE 102
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6497
Practice Address - Country:US
Practice Address - Phone:704-237-4042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14624101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional