Provider Demographics
NPI:1669638599
Name:HARRIS, ASHLEY WAYNE (LPC-A)
Entity Type:Individual
Prefix:MR
First Name:ASHLEY
Middle Name:WAYNE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 COLVARD ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-9797
Mailing Address - Country:US
Mailing Address - Phone:336-246-4542
Mailing Address - Fax:336-246-2364
Practice Address - Street 1:101 COLVARD ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-9797
Practice Address - Country:US
Practice Address - Phone:336-246-4542
Practice Address - Fax:336-246-4542
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12279101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC301100Medicaid
SC3333Medicare PIN