Provider Demographics
NPI:1093176349
Name:KIES, ASHLEY COSTNER (PHD, LPA, NCSP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:COSTNER
Last Name:KIES
Suffix:
Gender:F
Credentials:PHD, LPA, NCSP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:NICOLE
Other - Last Name:COSTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SSP, NCSP
Mailing Address - Street 1:1013 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-8329
Mailing Address - Country:US
Mailing Address - Phone:704-482-0250
Mailing Address - Fax:
Practice Address - Street 1:4012 PARK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-2377
Practice Address - Country:US
Practice Address - Phone:704-332-4834
Practice Address - Fax:704-372-9653
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist