Provider Demographics
NPI:1205353265
Name:PROPHET, FELICIA (LPC)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:PROPHET
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 N EXPRESSWAY STE 133
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-1746
Mailing Address - Country:US
Mailing Address - Phone:404-913-9183
Mailing Address - Fax:478-347-3120
Practice Address - Street 1:240 CORPORATE CENTER DR STE D
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7214
Practice Address - Country:US
Practice Address - Phone:404-913-9183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2020-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12631101YM0800X
GA010914101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health