| NPI | 1639296759 |
|---|---|
| Former Name | KELLEY FERGUSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS 2362) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 660) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2025-04-02 |