Provider Demographics
NPI:1679921043
Name:FERGUSON, DEBRA (PHD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2961A HUNTER MILL RD # 642
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-1704
Mailing Address - Country:US
Mailing Address - Phone:312-543-5107
Mailing Address - Fax:
Practice Address - Street 1:10300 BUSHMAN DR
Practice Address - Street 2:#300
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-1704
Practice Address - Country:US
Practice Address - Phone:703-705-2922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005928103TC0700X
VA0810005238103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical