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Individual
TIMOTHY FERGUSON
Active
Individual
TIMOTHY FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0102903
NJ MEDICAID PROVIDER
NJ
01
—
183739
YBA4
NJ
01
—
2000078
DHS LICENSE AMBULATORY
NJ
01
—
2000345
DHS LICENSE AMBULATORY CARE
NJ
01
—
2000345-MV1-10
DHS DMHAS MOBILE UNIT
NJ
01
—
215114000
MAGELLAN MIS
NJ
01
—
7603606
WFNJ-SAI GROUP
NJ
01
—
NJ-10046-M
SUBSTANCE ABUSE AND MENTAL HEALTH
NJ
Enumeration date
01/23/2014
Last updated
01/23/2014
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