MEDICARE: DR. LARRY PHILLIP FERRELL EDD, LCAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	1286	NC

General Provider Information

NPI Number	:	1548581267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY PHILLIP FERRELL EDD, LCAS

Provider Business Mailing Address
First Line	:	1690 WILMINGTON HWY
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-7547
Country	:	US
Telephone Number	:	910-938-2003
Fax Number	:	910-346-6092

Provider Business Practice Location Address
First Line	:	1690 WILMINGTON HWY
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-7547
Country	:	US
Telephone Number	:	910-938-2003
Fax Number	:	910-346-6092

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2010
Last Update Date	:	06/16/2010

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