Michael Wayne Ferguson Jr., LCSW, LISAC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-19807 Issued in AZ

Practice address

504 Tackett Farms Rd
Smyrna, GA 30082-3918

Phone

(980) 312-4166

NPI assigned

Jun 14, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Recovia LLCGroup PAC ID 1456629211, 28 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Recovia LLC

  • Specialist
  • Phoenix, AZ
  • NPI 1427421098
  Medicare reassignment Care Compare group NPD
• Evolvedmd, Inc.

  dba evolvedMD

  • Community/Behavioral Health Agency
  • Scottsdale, AZ
  • NPI 1821613704
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787097600000",
    "number": "1255781902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 TACKETT FARMS RD",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300823918",
            "telephone_number": "980-312-4166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 TACKETT FARMS RD",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300823918",
            "telephone_number": "980-312-4166"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19636 N 27th Ave Ste 106",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850274014",
            "country_code": "US",
            "telephone_number": "480-372-3286",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FERGUSON",
        "first_name": "MICHAEL",
        "middle_name": "WAYNE",
        "name_suffix": "Jr.",
        "credential": "LCSW, LISAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-14",
        "last_updated": "2026-08-19",
        "certification_date": "2026-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AZ",
            "license": "LISAC-155236",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW009914",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "LCSW-19807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSW",
            "identifier": "CSW009914",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSW",
            "identifier": "LCSW-19807",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LISAC",
            "identifier": "LISAC-155236",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mferguson@recovia.com",
            "affiliation": "Y",
            "affiliationName": "Recovia LLC",
            "address_1": "19636 N 27th Ave Ste 106",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "850274014",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• No Name Given Fathima Ambrin, DDS
• Amaya Faulkner-Taylor
• Alice F. Fazekas, PA
• Corinne Dion Felix
• Erin Ferguson
• Anthony P Ferrara
• Joshua Joseph Fertig, MD
• Taylor Fields
• Find Your Space the Ultimate Spa
• Mindy I Fine, M.D.

• Clinical Social Worker in Smyrna, GA
• Providers in Smyrna, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.