Provider Demographics
NPI:1346073608
Name:FERGUSON, LARA D (LAC, DIPLOM)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:D
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LAC, DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SNITZY DR
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-9026
Mailing Address - Country:US
Mailing Address - Phone:828-582-5403
Mailing Address - Fax:
Practice Address - Street 1:103 SNITZY DR
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-9026
Practice Address - Country:US
Practice Address - Phone:828-582-5403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC621171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist