MEDICARE: VICTORIA ELYSE 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	1041C0700X	Clinical Social Worker	0904015594	VA

General Provider Information

NPI Number	:	1679981625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA ELYSE FERGUSON

Provider Business Mailing Address
First Line	:	3922 RIVER BREEZE CIR
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-3170
Country	:	US
Telephone Number	:	757-339-4579
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 GITTINGS ST
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-6101
Country	:	US
Telephone Number	:	757-339-4579
Fax Number	:

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

Provider Enumeration Date	:	07/22/2014
Last Update Date	:	07/26/2023

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