Provider Demographics
NPI:1326220849
Name:FERGUSON, HEIDI RENEE (ASW)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:RENEE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:R
Other - Last Name:LUNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2390 E ORANGEWOOD AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-6138
Mailing Address - Country:US
Mailing Address - Phone:714-543-4333
Mailing Address - Fax:
Practice Address - Street 1:2390 E ORANGEWOOD AVE STE 300
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-6138
Practice Address - Country:US
Practice Address - Phone:714-543-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA890491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical