MEDICARE: DAWN FERGUSON LPC

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	101YP2500X	Professional Counselor	PC013500	PA

General Provider Information

NPI Number	:	1649971383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN FERGUSON LPC

Provider Business Mailing Address
First Line	:	1727 N BAMBREY ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19121-2812
Country	:	US
Telephone Number	:	267-257-8867
Fax Number	:

Provider Business Practice Location Address
First Line	:	1727 N BAMBREY ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19121-2812
Country	:	US
Telephone Number	:	267-257-8867
Fax Number	:

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

Provider Enumeration Date	:	03/10/2023
Last Update Date	:	03/10/2023

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Directions to “ DAWN FERGUSON LPC” Practice Location

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