Provider Demographics
NPI:1801917414
Name:FERGUSON, STEPHANIE WESCH (LCSW)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:WESCH
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:DIAN
Other - Last Name:WESCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:9513 STONEMEADOW CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3880
Mailing Address - Country:US
Mailing Address - Phone:804-433-9969
Mailing Address - Fax:
Practice Address - Street 1:2819 N PARHAM RD STE 130
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4425
Practice Address - Country:US
Practice Address - Phone:804-677-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA090400064791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical