Provider Demographics
NPI:1043959521
Name:FERGUSON, DELANEY ALEENE (QMHP-T, BS, RBT)
Entity type:Individual
Prefix:MS
First Name:DELANEY
Middle Name:ALEENE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:QMHP-T, BS, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 WHARTON ST SE APT 3
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-4882
Mailing Address - Country:US
Mailing Address - Phone:434-305-5127
Mailing Address - Fax:
Practice Address - Street 1:1320 PLANTATION RD NE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-5713
Practice Address - Country:US
Practice Address - Phone:540-266-7903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-22-217704106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician