Provider Demographics
NPI:1790250587
Name:FERGUSON-MANLY, FAYE LEONA
Entity Type:Individual
Prefix:
First Name:FAYE
Middle Name:LEONA
Last Name:FERGUSON-MANLY
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 1:2975 TREAT BLVD STE B5
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-3687
Mailing Address - Country:US
Mailing Address - Phone:925-691-5083
Mailing Address - Fax:
Practice Address - Street 1:2975 TREAT BLVD STE B5
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-3687
Practice Address - Country:US
Practice Address - Phone:925-691-5083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)