Provider Demographics
NPI:1508113002
Name:CALLICUTT, ASHLEY NEAL (PHD, LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:NEAL
Last Name:CALLICUTT
Suffix:
Gender:F
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SEA ISLAND ROAD,
Mailing Address - Street 2:SUITE G
Mailing Address - City:ST. SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522
Mailing Address - Country:US
Mailing Address - Phone:214-402-1014
Mailing Address - Fax:
Practice Address - Street 1:301 SEA ISLAND ROAD,
Practice Address - Street 2:SUITE G
Practice Address - City:ST. SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522
Practice Address - Country:US
Practice Address - Phone:214-402-1014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006870101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional