Provider Demographics
NPI:1023240678
Name:CHANCELLOR, ASHLEY DUNSTON (MED, ITFS)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DUNSTON
Last Name:CHANCELLOR
Suffix:
Gender:F
Credentials:MED, ITFS
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:RENEE'
Other - Last Name:DUNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 97051
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27624-7051
Mailing Address - Country:US
Mailing Address - Phone:919-478-9974
Mailing Address - Fax:
Practice Address - Street 1:10704 DEBMOOR PL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7018
Practice Address - Country:US
Practice Address - Phone:919-478-9974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300082KMedicaid