Provider Demographics
NPI:1609309145
Name:BARKSDALE, ASHLEY (LCSW, CFLE, CADC II)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BARKSDALE
Suffix:
Gender:F
Credentials:LCSW, CFLE, CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5374 HIGHWAY 45 N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2947
Mailing Address - Country:US
Mailing Address - Phone:662-368-2008
Mailing Address - Fax:
Practice Address - Street 1:5374 HIGHWAY 45 N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2947
Practice Address - Country:US
Practice Address - Phone:662-368-2008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5726C1041C0700X
MSAD23-052B101YA0400X
MSC109531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS200009883Medicaid
MS200009708Medicaid
MS200009755Medicaid