Provider Demographics
NPI:1477822161
Name:MEDFORD, ASHLEY HART (LPC)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:HART
Last Name:MEDFORD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4827 TOWER RD
Mailing Address - Street 2:UNIT E
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-5864
Mailing Address - Country:US
Mailing Address - Phone:336-399-4546
Mailing Address - Fax:
Practice Address - Street 1:4827 TOWER RD
Practice Address - Street 2:UNIT E
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-5864
Practice Address - Country:US
Practice Address - Phone:336-399-4546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-24
Last Update Date:2011-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8084101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional