Healthcare Provider Details

I. General information

NPI: 1609700020
Provider Name (Legal Business Name): ASHANTI MCCALLISTER LMBT 09636
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321 REDGATE DR
DURHAM NC
27703-4757
US

IV. Provider business mailing address

3321 REDGATE DR
DURHAM NC
27703-4757
US

V. Phone/Fax

Practice location:
  • Phone: 919-945-6240
  • Fax:
Mailing address:
  • Phone: 919-945-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number09636
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: