Provider Demographics
NPI:1093405920
Name:FERGUSON, DHURANIQUE DAPHNE LAURA
Entity type:Individual
Prefix:MISS
First Name:DHURANIQUE
Middle Name:DAPHNE LAURA
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 25TH ST NE APT 1604
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3972
Mailing Address - Country:US
Mailing Address - Phone:423-813-9579
Mailing Address - Fax:
Practice Address - Street 1:1120 N OCOEE ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-4475
Practice Address - Country:US
Practice Address - Phone:423-380-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist