Provider Demographics
NPI:1972103992
Name:FERGUSON, NADINE
Entity type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NADINE
Other - Middle Name:ATHENA
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5932 FOLKSTONE LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-9417
Mailing Address - Country:US
Mailing Address - Phone:954-439-4554
Mailing Address - Fax:
Practice Address - Street 1:5932 FOLKSTONE LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-9417
Practice Address - Country:US
Practice Address - Phone:954-439-4554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23403101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health