Provider Demographics
NPI:1609650522
Name:DYAL, ASHLEY (LISW-CP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:DYAL
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 MOUNT BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:WARE SHOALS
Mailing Address - State:SC
Mailing Address - Zip Code:29692-2949
Mailing Address - Country:US
Mailing Address - Phone:864-715-2220
Mailing Address - Fax:
Practice Address - Street 1:1360 MOUNT BETHEL RD
Practice Address - Street 2:
Practice Address - City:WARE SHOALS
Practice Address - State:SC
Practice Address - Zip Code:29692-2949
Practice Address - Country:US
Practice Address - Phone:864-715-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC163021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical