Provider Demographics
NPI:1407218878
Name:BELT, ASHLEY LEITNER (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LEITNER
Last Name:BELT
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:BROOKE
Other - Last Name:LEITNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8620 REFUGE POINT CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-6879
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8620 REFUGE POINT CIR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-6879
Practice Address - Country:US
Practice Address - Phone:843-793-8147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1-15-19837103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst