Provider Demographics
NPI:1194430199
Name:FERGUSON, LYDIA KAY (LPC)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:KAY
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3631 THAXTON MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-5485
Mailing Address - Country:US
Mailing Address - Phone:434-515-3576
Mailing Address - Fax:
Practice Address - Street 1:402 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-2017
Practice Address - Country:US
Practice Address - Phone:434-533-1088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011264101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional