Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 3945 | NC |
NPI | 1063648731 |
---|---|
Provider Name | Dr. Tara M. Ferguson |
First Address | Wilmington, NC 28403-7015 |
Second Address | Wilmington, NC 28403-7015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2009 |
Last Update Date | 03/05/2018 |