Healthcare Provider Details

I. General information

NPI: 1932030558
Provider Name (Legal Business Name): TONYA RENEE FERGUSON CPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 WHEATON AVE
YOUNGSVILLE NC
27596-8691
US

IV. Provider business mailing address

78 WHEATON AVE
YOUNGSVILLE NC
27596-8691
US

V. Phone/Fax

Practice location:
  • Phone: 919-529-2474
  • Fax:
Mailing address:
  • Phone: 919-529-2474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5005347
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: