Provider Demographics
NPI:1942687306
Name:HARRISON, ASHLEIGH JORDAN (MA, LPC-A, NCC)
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:JORDAN
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MA, LPC-A, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 PARK ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-2230
Mailing Address - Country:US
Mailing Address - Phone:980-228-2868
Mailing Address - Fax:
Practice Address - Street 1:4108 PARK ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-2230
Practice Address - Country:US
Practice Address - Phone:980-228-2868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11245101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional