Provider Demographics
NPI:1396892360
Name:FERGUSON, TAMERA NANEKE (LCSW)
Entity type:Individual
Prefix:MS
First Name:TAMERA
Middle Name:NANEKE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:405 PHILIP BLVD
Mailing Address - Street 2:APT 710
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8738
Mailing Address - Country:US
Mailing Address - Phone:706-540-6477
Mailing Address - Fax:770-962-3842
Practice Address - Street 1:405 PHILIP BLVD
Practice Address - Street 2:APT 710
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8738
Practice Address - Country:US
Practice Address - Phone:706-540-6477
Practice Address - Fax:770-962-3842
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0043191041C0700X
GA4343771041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool