Provider Demographics
NPI:1043634637
Name:ULBRICHT, ASHLEY BROOKE UNDERWOOD (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:BROOKE UNDERWOOD
Last Name:ULBRICHT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:BROOKE
Other - Last Name:UNDERWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:828 WAPPOO RD
Mailing Address - Street 2:828 WAPPOO ROAD
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5865
Mailing Address - Country:US
Mailing Address - Phone:843-297-8470
Mailing Address - Fax:843-278-9319
Practice Address - Street 1:828 WAPPOO RD
Practice Address - Street 2:828 WAPPOO ROAD
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5865
Practice Address - Country:US
Practice Address - Phone:843-297-8470
Practice Address - Fax:843-278-9319
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-15-20994103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst