Provider Demographics
NPI:1235553447
Name:FERGUSON, PORCIA (RAS)
Entity Type:Individual
Prefix:
First Name:PORCIA
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4023 MARINE AVE
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1840
Mailing Address - Country:US
Mailing Address - Phone:310-675-9555
Mailing Address - Fax:310-263-1909
Practice Address - Street 1:4023 MARINE AVE
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1840
Practice Address - Country:US
Practice Address - Phone:310-675-9555
Practice Address - Fax:310-263-1909
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor