Provider Demographics
NPI:1114219177
Name:FERGUSON, DEBRA HUTTON (LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:HUTTON
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BRIARCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-4405
Mailing Address - Country:US
Mailing Address - Phone:910-890-6837
Mailing Address - Fax:910-582-8370
Practice Address - Street 1:1120 W BROAD ST STE B
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-4605
Practice Address - Country:US
Practice Address - Phone:910-808-1733
Practice Address - Fax:919-901-4005
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7780101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104991Medicaid