Provider Demographics
NPI:1023539111
Name:ANDERSON, ASHLEY (BCBA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4395 DASHLEY CIR
Mailing Address - Street 2:
Mailing Address - City:CATAWBA
Mailing Address - State:SC
Mailing Address - Zip Code:29704-9528
Mailing Address - Country:US
Mailing Address - Phone:803-504-4861
Mailing Address - Fax:
Practice Address - Street 1:225 HERLONG AVE S STE 250
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2147
Practice Address - Country:US
Practice Address - Phone:803-504-4861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
SC11729079103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst