Healthcare Provider Details

I. General information

NPI: 1225708662
Provider Name (Legal Business Name): LAURA MARIE FERGUSON BHCMII, BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 02/07/2024
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 WELLNESS DR
SUMMERSVILLE WV
26651-5402
US

IV. Provider business mailing address

131 WELLNESS DR
SUMMERSVILLE WV
26651-5402
US

V. Phone/Fax

Practice location:
  • Phone: 888-736-3229
  • Fax: 304-497-0516
Mailing address:
  • Phone: 918-342-0770
  • Fax: 304-497-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberH2011
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: