Provider Demographics
NPI:1033663885
Name:FOGG, ASHLEIGH (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:
Last Name:FOGG
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20316 LOBO LN
Mailing Address - Street 2:APARTMENT #301
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-0161
Mailing Address - Country:US
Mailing Address - Phone:919-358-7671
Mailing Address - Fax:
Practice Address - Street 1:635 COX RD
Practice Address - Street 2:SUITE B
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3424
Practice Address - Country:US
Practice Address - Phone:704-691-7561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0106901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical