Doctor Name: | MRS. PHYLLIS FERGUSON-COLLUM |
NPI Number: | 1902202054 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 149015907 |
Business Practice Address: | 15539 Dobson Ave Dolton, IL - 604192708 |
Business Phone Number: | 3128105203 |
Business Fax Number: | 7736543875 |
Mailing Address: | 15539 Dobson Ave, DOLTON |
State: | IL |
Postal Code: | 604192708 |
Phone Number: | 3128105203 |
Fax Number: | 7736543875 |
NPI Enumeration Date: | 11/17/2014 |
NPI Last Update Date: | 11/17/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 149015907 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |