Individual
MS. TYRA LAKIA FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
651 W WARREN AVE STE 100, LONGWOOD, FL 32750-4036
(786) 306-0177
Mailing address
1454 SUNSHADOW DR APT 100, CASSELBERRY, FL 32707-9001
(786) 306-0177
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
04/11/2023
Last updated
04/11/2023
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