Provider Demographics
NPI:1336568062
Name:MACON, ASHLEY (LPC-I)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MACON
Suffix:
Gender:F
Credentials:LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4246
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29240-4246
Mailing Address - Country:US
Mailing Address - Phone:803-786-1844
Mailing Address - Fax:803-754-7783
Practice Address - Street 1:3809 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-3533
Practice Address - Country:US
Practice Address - Phone:803-786-1844
Practice Address - Fax:803-754-7783
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6236101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
01OtherTHE COMMISSION ON REHABILITATION COUNSELOR CERTIFICATION (CRCC)