Provider Demographics
NPI:1003648221
Name:BURKS, ASHLEY LAUREN (RPRS-IFPRS,CPRS)
Entity type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:LAUREN
Last Name:BURKS
Suffix:
Gender:F
Credentials:RPRS-IFPRS,CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4009
Mailing Address - Country:US
Mailing Address - Phone:434-221-4153
Mailing Address - Fax:
Practice Address - Street 1:161 SMITH RD
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-4009
Practice Address - Country:US
Practice Address - Phone:434-221-4153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0735000844175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist