Provider Demographics
NPI:1891148862
Name:FERRELL, ESTELLA BERNIECE (LCSWA)
Entity Type:Individual
Prefix:
First Name:ESTELLA
Middle Name:BERNIECE
Last Name:FERRELL
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:ESTELLA
Other - Middle Name:BERNIECE
Other - Last Name:FERRELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5456 FOXWOOD DR NE
Mailing Address - Street 2:
Mailing Address - City:RIEGELWOOD
Mailing Address - State:NC
Mailing Address - Zip Code:28456-9303
Mailing Address - Country:US
Mailing Address - Phone:740-821-0542
Mailing Address - Fax:
Practice Address - Street 1:411 COURT ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3932
Practice Address - Country:US
Practice Address - Phone:740-354-6685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHICDC131169101YA0400X
OHS1502368104100000X
NCP0114111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker