Healthcare Provider Details

I. General information

NPI: 1285391730
Provider Name (Legal Business Name): SARAH LASHAY RHENA FERGUSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3094 W MARKET ST STE 343
FAIRLAWN OH
44333-3618
US

IV. Provider business mailing address

817 ORLANDO AVE
AKRON OH
44320-1812
US

V. Phone/Fax

Practice location:
  • Phone: 234-334-5589
  • Fax:
Mailing address:
  • Phone: 330-322-2529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCIII.162384
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2613941
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: