Provider Demographics
NPI:1811285323
Name:FERGUSON, MICHEAL JAVON (LCAS-P, LCSW-P)
Entity type:Individual
Prefix:
First Name:MICHEAL
Middle Name:JAVON
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:LCAS-P, LCSW-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8430 UNIVERSITY EXECUTIVE PARK DR.
Mailing Address - Street 2:655
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262
Mailing Address - Country:US
Mailing Address - Phone:704-596-5553
Mailing Address - Fax:704-596-1556
Practice Address - Street 1:8430 UNIVERSITY EXECUTIVE PARK DR.
Practice Address - Street 2:655
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262
Practice Address - Country:US
Practice Address - Phone:704-596-5553
Practice Address - Fax:704-596-1556
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP006435104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker