Provider Demographics
NPI:1942053442
Name:BROWN, ASHIA (EDS, LPES)
Entity Type:Individual
Prefix:MRS
First Name:ASHIA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:EDS, LPES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4814 CANE POLE LN
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-9044
Mailing Address - Country:US
Mailing Address - Phone:843-608-1733
Mailing Address - Fax:
Practice Address - Street 1:6859 HYDE FARM RD
Practice Address - Street 2:
Practice Address - City:RAVENEL
Practice Address - State:SC
Practice Address - Zip Code:29470-5372
Practice Address - Country:US
Practice Address - Phone:843-532-4923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool