Provider Demographics
NPI:1619092988
Name:FERGUSON, BRUCE ANDREW (LCPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ANDREW
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E FORT AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4628
Mailing Address - Country:US
Mailing Address - Phone:305-793-5583
Mailing Address - Fax:
Practice Address - Street 1:109 W BEL AIR AVE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-3221
Practice Address - Country:US
Practice Address - Phone:410-297-2271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2292101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional