Provider Demographics
NPI:1861035610
Name:FERGUSON, RICKY WILSON
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:WILSON
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4671 COUNTRY LN APT 108
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5823
Mailing Address - Country:US
Mailing Address - Phone:216-317-9703
Mailing Address - Fax:440-822-3716
Practice Address - Street 1:4671 COUNTRY LN APT 108
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-5823
Practice Address - Country:US
Practice Address - Phone:216-317-9703
Practice Address - Fax:440-822-3716
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)