Healthcare Provider Details

I. General information

NPI: 1518118918
Provider Name (Legal Business Name): CASEY ELIZABETH FERGUSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASEY ELIZABETH HENSHAW FERGUSON LPC

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6580 VALLEY CENTER DR STE 169
FAIRLAWN VA
24141-5694
US

IV. Provider business mailing address

2795 HAYNES RD
PULASKI VA
24301-5068
US

V. Phone/Fax

Practice location:
  • Phone: 540-505-2986
  • Fax:
Mailing address:
  • Phone: 540-505-2986
  • Fax: 540-380-0079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0701004402
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004402
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number07010044002
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: