Provider Demographics
NPI:1801433180
Name:FERRERIA-FONG, KATHERINE TEOFISTA (LCPC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:TEOFISTA
Last Name:FERRERIA-FONG
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5614 N MULLIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-6129
Mailing Address - Country:US
Mailing Address - Phone:904-415-2919
Mailing Address - Fax:
Practice Address - Street 1:5614 N MULLIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-6129
Practice Address - Country:US
Practice Address - Phone:904-415-2919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180013592101YP2500X
IL178.014527101YP2500X
IL180.013592101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional