Healthcare Provider Details

I. General information

NPI: 1679638951
Provider Name (Legal Business Name): ROBERT FERGUSON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 W MAIN ST SUITE #301
DURHAM NC
27705-4683
US

IV. Provider business mailing address

103 MILL ROCK CT
CARRBORO NC
27510-4109
US

V. Phone/Fax

Practice location:
  • Phone: 919-286-3453
  • Fax: 919-286-7033
Mailing address:
  • Phone: 919-918-7635
  • Fax: 919-286-7033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2539
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: