Provider Demographics
NPI:1578791414
Name:ASHLOCK, REBEKAH DAUGHERTY (LCSW)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:DAUGHERTY
Last Name:ASHLOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:DAUGHERTY
Other - Last Name:ROCHELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:247 E CONOLLY CT
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-3964
Mailing Address - Country:US
Mailing Address - Phone:910-777-9932
Mailing Address - Fax:910-777-9932
Practice Address - Street 1:247 E CONOLLY CT
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-3964
Practice Address - Country:US
Practice Address - Phone:910-777-9932
Practice Address - Fax:910-777-9932
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0063871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical