Provider Demographics
NPI:1356637078
Name:FERGUSON, KARON T (LPC, MAC)
Entity Type:Individual
Prefix:
First Name:KARON
Middle Name:T
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LPC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 OLD PHOENIX RD STE I
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-5007
Mailing Address - Country:US
Mailing Address - Phone:706-623-2334
Mailing Address - Fax:706-243-6402
Practice Address - Street 1:646 OLD PHOENIX RD STE I
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-5007
Practice Address - Country:US
Practice Address - Phone:706-623-2334
Practice Address - Fax:706-243-6402
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007726101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional