Individual
CARLTON EDWARD FERGUSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC #31124
Contact information
Practice address
614 W MARQUETTE RD APT 1A, CHICAGO, IL 60621-2765
(312) 343-8952
Mailing address
614 W MARQUETTE RD APT 1A, CHICAGO, IL 60621-2765
(312) 343-8952
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
31124
IL
101YP2500X
Professional Counselor
31124
IL
106H00000X
Marriage & Family Therapist
31124
IL
171M00000X
Case Manager/Care Coordinator
31124
IL
172V00000X
Community Health Worker
31124
IL
175T00000X
Peer Specialist
31124
IL
302F00000X
Exclusive Provider Organization
31124
IL
305S00000X
Point of Service
31124
IL
405300000X
Prevention Professional
31124
IL
Other
Enumeration date
10/17/2024
Last updated
10/19/2024
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