Provider Demographics
NPI:1578078663
Name:ASHFORD, EURSEL NICOLE (COSMETOLOGIST)
Entity Type:Individual
Prefix:
First Name:EURSEL
Middle Name:NICOLE
Last Name:ASHFORD
Suffix:
Gender:F
Credentials:COSMETOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 ROSEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:SC
Mailing Address - Zip Code:29061-8389
Mailing Address - Country:US
Mailing Address - Phone:803-397-4216
Mailing Address - Fax:803-232-7944
Practice Address - Street 1:128 S ASSEMBLY ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-4545
Practice Address - Country:US
Practice Address - Phone:803-397-4216
Practice Address - Fax:803-232-7944
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-11
Last Update Date:2019-03-19
Deactivation Date:2018-03-19
Deactivation Code:
Reactivation Date:2018-04-25
Provider Licenses
StateLicense IDTaxonomies
SC626841744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCS8095OtherHAIRPIECE FOR ALOPECIA
SC1744P3200XOtherCERTIFIED HAIR LOSS SPECIALIST
SCA9272OtherMEDICAL UNIT
SCA9282OtherCRANIAL PROSTHESIS