Provider Demographics
NPI:1700165404
Name:BUCKHOUT, ASHLEY HEATHER (MS, LCAS)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:HEATHER
Last Name:BUCKHOUT
Suffix:
Gender:F
Credentials:MS, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 HEALTH DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7704
Mailing Address - Country:US
Mailing Address - Phone:252-413-1965
Mailing Address - Fax:252-413-0500
Practice Address - Street 1:116 HEALTH DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7704
Practice Address - Country:US
Practice Address - Phone:252-413-1965
Practice Address - Fax:252-413-0500
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NC1885101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112268Medicaid