Provider Demographics
NPI:1740811504
Name:FERGUSON, CAMBIE (SUDPT)
Entity type:Individual
Prefix:
First Name:CAMBIE
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16107 NE 103RD ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3031
Mailing Address - Country:US
Mailing Address - Phone:425-518-6100
Mailing Address - Fax:
Practice Address - Street 1:16225 NE 87TH ST STE B-3
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3536
Practice Address - Country:US
Practice Address - Phone:425-968-5921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61034971101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)