Provider Demographics
NPI:1457944142
Name:PETERS, ASHLEY L (LCSWA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:L
Last Name:PETERS
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S BOYLAN AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1848
Mailing Address - Country:US
Mailing Address - Phone:240-446-8841
Mailing Address - Fax:
Practice Address - Street 1:121 S BOYLAN AVE APT 4
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1848
Practice Address - Country:US
Practice Address - Phone:240-446-8841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0156301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical