Provider Demographics
NPI:1093575516
Name:FERGUSON, PRIA (RBT)
Entity type:Individual
Prefix:
First Name:PRIA
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COMMERCE CT
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-9445
Mailing Address - Country:US
Mailing Address - Phone:615-560-6622
Mailing Address - Fax:
Practice Address - Street 1:5000 BUSINESS CENTER DR STE 500
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-7423
Practice Address - Country:US
Practice Address - Phone:912-295-4956
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-23-269497106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician