Provider Demographics
NPI:1689309858
Name:MCFERSON, LAURIELLE (CDCA, RA)
Entity Type:Individual
Prefix:
First Name:LAURIELLE
Middle Name:
Last Name:MCFERSON
Suffix:
Gender:F
Credentials:CDCA, RA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 E LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2926
Mailing Address - Country:US
Mailing Address - Phone:614-235-4448
Mailing Address - Fax:
Practice Address - Street 1:1409 E LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2926
Practice Address - Country:US
Practice Address - Phone:614-235-4448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA180189101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)