Healthcare Provider Details

I. General information

NPI: 1811444904
Provider Name (Legal Business Name): ASHLEY FERGUSON MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MISSIONARY RDG
BIRMINGHAM AL
35242-5236
US

IV. Provider business mailing address

100 MISSIONARY RDG
BIRMINGHAM AL
35242-5236
US

V. Phone/Fax

Practice location:
  • Phone: 205-967-3660
  • Fax:
Mailing address:
  • Phone: 205-967-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1259
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1259
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: