Provider Demographics
NPI:1760133748
Name:THWAITES, ASHLEY DAMON (LMFT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DAMON
Last Name:THWAITES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 CASTLE PINES DR
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-4468
Mailing Address - Country:US
Mailing Address - Phone:404-993-5505
Mailing Address - Fax:
Practice Address - Street 1:144 CASTLE PINES DR
Practice Address - Street 2:
Practice Address - City:BONAIRE
Practice Address - State:GA
Practice Address - Zip Code:31005-4468
Practice Address - Country:US
Practice Address - Phone:404-993-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001930106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist