Provider Demographics
NPI:1083483754
Name:ASHLEY, AMANDA
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DEWITT ST # 10
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-5649
Mailing Address - Country:US
Mailing Address - Phone:910-358-1484
Mailing Address - Fax:
Practice Address - Street 1:2 DEWITT ST # 10
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5649
Practice Address - Country:US
Practice Address - Phone:910-939-1127
Practice Address - Fax:855-978-1077
Is Sole Proprietor?:No
Enumeration Date:2023-12-22
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1167598101YS0200X
NCA19421101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool