Provider Demographics
NPI:1326519802
Name:FERGUSON, IRENE ELIZABETH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:ELIZABETH
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4023 DEERBROOK WAY SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3220
Mailing Address - Country:US
Mailing Address - Phone:404-263-8684
Mailing Address - Fax:
Practice Address - Street 1:912 KILLIAN HILL RD SW STE 202E
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3110
Practice Address - Country:US
Practice Address - Phone:770-765-7759
Practice Address - Fax:678-658-2215
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010204101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional