Provider Demographics
NPI:1417066549
Name:FELICIA, GEORGENA (LPCC, LMFT)
Entity Type:Individual
Prefix:
First Name:GEORGENA
Middle Name:
Last Name:FELICIA
Suffix:
Gender:F
Credentials:LPCC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6837 GLENDORA DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109
Mailing Address - Country:US
Mailing Address - Phone:505-350-6202
Mailing Address - Fax:
Practice Address - Street 1:6837 GLENDORA DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-856-9661
Practice Address - Fax:505-856-9661
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1697101YP2500X, 101YP2500X
NM1698106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist