Provider Demographics
NPI:1821745407
Name:BLACKMON, ASHLEY RENAE
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:RENAE
Last Name:BLACKMON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:RENAE
Other - Last Name:BLACKMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3500 7TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35222-3211
Mailing Address - Country:US
Mailing Address - Phone:205-490-8228
Mailing Address - Fax:
Practice Address - Street 1:4778 OVERTON RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35210-3803
Practice Address - Country:US
Practice Address - Phone:052-957-0294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician