Provider Demographics
NPI:1649033002
Name:FERGUSON, OLIVIA WILSON (LPC, NCC, CCTP)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:WILSON
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LPC, NCC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8609 W WILDERNESS WAY
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-6121
Mailing Address - Country:US
Mailing Address - Phone:318-455-3965
Mailing Address - Fax:
Practice Address - Street 1:670 ALBEMARLE DR STE 1403
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-5945
Practice Address - Country:US
Practice Address - Phone:318-455-3965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8365101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health