Provider Demographics
NPI:1336735364
Name:FEATHERINGILL, LORI (LMHC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:FEATHERINGILL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:FEATHERINGILL
Other - Last Name:TIMBERLAKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:1776 FIDDLERS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-7240
Mailing Address - Country:US
Mailing Address - Phone:706-551-9001
Mailing Address - Fax:
Practice Address - Street 1:1776 FIDDLERS RIDGE DR
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-7240
Practice Address - Country:US
Practice Address - Phone:706-551-9001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10215101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health