Provider Demographics
NPI:1427220672
Name:FERGUSON, DORSINE LAJUNE
Entity Type:Individual
Prefix:MRS
First Name:DORSINE
Middle Name:LAJUNE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-4717
Mailing Address - Country:US
Mailing Address - Phone:707-655-5747
Mailing Address - Fax:707-980-7545
Practice Address - Street 1:420 E O ST
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-2861
Practice Address - Country:US
Practice Address - Phone:707-297-6393
Practice Address - Fax:707-297-6445
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)