Provider Demographics
NPI:1780805234
Name:FERGUSON, MITCHELL RAY (EDD LPC NCC)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:RAY
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:EDD LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 CAPE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004
Mailing Address - Country:US
Mailing Address - Phone:770-555-1111
Mailing Address - Fax:
Practice Address - Street 1:2550 NORTHWINDS PARKWAY
Practice Address - Street 2:SUITE 400
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004
Practice Address - Country:US
Practice Address - Phone:678-319-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC04070101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health