Provider Demographics
NPI:1720440027
Name:FERGUSON, AHKEE (LICDC)
Entity type:Individual
Prefix:MR
First Name:AHKEE
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981 CELINA AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-1616
Mailing Address - Country:US
Mailing Address - Phone:330-803-8112
Mailing Address - Fax:
Practice Address - Street 1:11027 TAHITI ISLE LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3721
Practice Address - Country:US
Practice Address - Phone:330-803-8112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-25
Last Update Date:2024-10-02
Deactivation Date:2018-03-16
Deactivation Code:
Reactivation Date:2018-03-21
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.141134101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0256236Medicaid