Provider Demographics
NPI:1811572878
Name:DAMPIER, ASHANTI SAMONE
Entity Type:Individual
Prefix:
First Name:ASHANTI
Middle Name:SAMONE
Last Name:DAMPIER
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 1:4735 OLD CANTON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-5527
Mailing Address - Country:US
Mailing Address - Phone:601-354-0983
Mailing Address - Fax:
Practice Address - Street 1:4735 OLD CANTON RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5527
Practice Address - Country:US
Practice Address - Phone:601-354-0983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker