Provider Demographics
NPI:1417540212
Name:FERGUSON, DANIEL (BT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10686 CRESTWOOD DR STE B
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-4407
Mailing Address - Country:US
Mailing Address - Phone:703-392-6166
Mailing Address - Fax:703-392-3885
Practice Address - Street 1:10686 CRESTWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-4407
Practice Address - Country:US
Practice Address - Phone:703-392-6166
Practice Address - Fax:703-392-3885
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician