Provider Demographics
NPI:1952508368
Name:FERGUSSON, ADELE CHRISTINE (LCSW)
Entity Type:Individual
Prefix:
First Name:ADELE
Middle Name:CHRISTINE
Last Name:FERGUSSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1198 NAVIGATOR DR # 123
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-4334
Mailing Address - Country:US
Mailing Address - Phone:805-650-6939
Mailing Address - Fax:
Practice Address - Street 1:1198 NAVIGATOR DR # 123
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-4334
Practice Address - Country:US
Practice Address - Phone:805-650-6939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 110141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical