Provider Demographics
NPI:1043038656
Name:FERENCHIK, ANDREA LINN
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LINN
Last Name:FERENCHIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 HEDGEMOORE CT
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9454
Mailing Address - Country:US
Mailing Address - Phone:678-852-3807
Mailing Address - Fax:
Practice Address - Street 1:314 TRIBBLE GAP RD STE B
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2475
Practice Address - Country:US
Practice Address - Phone:770-615-8285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009787101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional