Provider Demographics
NPI:1407906985
Name:FARRELL, GINA N (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:N
Last Name:FARRELL
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2045
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-2045
Mailing Address - Country:US
Mailing Address - Phone:912-658-5392
Mailing Address - Fax:
Practice Address - Street 1:272 S. COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326
Practice Address - Country:US
Practice Address - Phone:912-658-5392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4076101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional