Provider Demographics
NPI:1225521362
Name:ASHLEY, CHARLES LEE JR
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:LEE
Last Name:ASHLEY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 JOANNE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-2757
Mailing Address - Country:US
Mailing Address - Phone:704-674-4383
Mailing Address - Fax:
Practice Address - Street 1:411 ANDREWS RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2993
Practice Address - Country:US
Practice Address - Phone:919-682-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC$$$$$$$$$Medicaid