Healthcare Provider Details

I. General information

NPI: 1205236460
Provider Name (Legal Business Name): ASHLEY NICOLE PHELPS M.A. LPA, HSP-PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY NICOLE AIKMAN M.A., LPA, HSP-PA

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S SALEM ST STE 228
APEX NC
27502-1863
US

IV. Provider business mailing address

1500 PADSTONE DR
APEX NC
27502-6520
US

V. Phone/Fax

Practice location:
  • Phone: 919-249-8053
  • Fax:
Mailing address:
  • Phone: 214-649-6356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4549
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: