Individual
MICHAEL WAYNE FERGUSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, LISAC
Contact information
Practice address
19636 N 27TH AVE STE 106, PHOENIX, AZ 85027-4014
(480) 372-3286
Mailing address
6708 W UTOPIA RD STE 1005, GLENDALE, AZ 85308-5507
(980) 312-4166
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LISAC-155236
AZ
1041C0700X
Clinical Social Worker
Primary
LCSW-19807
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCSW-19807
LCSW
AZ
01
—
LISAC-155236
LISAC
AZ
Enumeration date
06/14/2016
Last updated
03/16/2022
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