=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427264977
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FERRIS COUNSELING & CONSULTING, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2007
-----------------------------------------------------
Last Update Date | 01/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4801 SIX FORKS RD
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27609-5205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-676-7800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1212 KERSHAW DR
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27609-5575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-676-7800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MICHAEL FERRIS
-----------------------------------------------------
Credential | MSW, LCSW
-----------------------------------------------------
Telephone | 919-676-7800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | C003515
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | C002986
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------