Provider Demographics
NPI:1750024600
Name:MARTIN, ASHLEY WHITE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:WHITE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5613 VIRGILWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-2227
Mailing Address - Country:US
Mailing Address - Phone:336-317-9034
Mailing Address - Fax:
Practice Address - Street 1:5613 VIRGILWOOD DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-2227
Practice Address - Country:US
Practice Address - Phone:336-317-9034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health