Provider Demographics
NPI:1619222387
Name:FERGUSON, SOPHIA MARIE (LGSW)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:MARIE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12270 POTOMAC VIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20664-2250
Mailing Address - Country:US
Mailing Address - Phone:301-641-4790
Mailing Address - Fax:
Practice Address - Street 1:12270 POTOMAC VIEW DR
Practice Address - Street 2:
Practice Address - City:NEWBURG
Practice Address - State:MD
Practice Address - Zip Code:20664-2250
Practice Address - Country:US
Practice Address - Phone:301-641-4790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30464104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker