Healthcare Provider Details

I. General information

NPI: 1801835301
Provider Name (Legal Business Name): PONTIAC CHILDREN'S SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 W HURON ST
PONTIAC MI
48341-1414
US

IV. Provider business mailing address

160 W HURON ST
PONTIAC MI
48341-1414
US

V. Phone/Fax

Practice location:
  • Phone: 248-334-3100
  • Fax: 248-334-3112
Mailing address:
  • Phone: 248-334-3100
  • Fax: 248-334-3112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberC-1630279470
License Number StateMI

VIII. Authorized Official

Name: MRS. DEBORAH FERGUSON
Title or Position: PSYCHIATRIC
Credential: M.D.
Phone: 248-877-8559