Individual
MARY C FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
60 W SUNBRIDGE DR, FAYETTEVILLE, AR 72703-1822
(479) 695-1240
(479) 695-1242
Mailing address
2400 S 48TH ST, SPRINGDALE, AR 72762-6683
(479) 750-2020
(479) 750-4843
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7291-M
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
203514795
MEDICAID PIN
AR
Enumeration date
08/05/2014
Last updated
02/09/2015
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