MEDICARE: VIVIAN FERGUSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CAADE PENDING	CA

General Provider Information

NPI Number	:	1518162759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN FERGUSON

Provider Business Mailing Address
First Line	:	510 WOLLAM AVE
Second Line	:
City	:	BAY POINT
State	:	CA
Zip	:	94565-4364
Country	:	US
Telephone Number	:	925-458-1978
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 WOLLAM AVE
Second Line	:
City	:	BAY POINT
State	:	CA
Zip	:	94565-4364
Country	:	US
Telephone Number	:	925-458-1978
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	07/08/2007

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Directions to “ VIVIAN FERGUSON ” Practice Location

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