Healthcare Provider Details

I. General information

NPI: 1336053529
Provider Name (Legal Business Name): ASHLEY ALISA DOUGLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5429 THOMPSON CIR
HOPE MILLS NC
28348-1930
US

IV. Provider business mailing address

5429 THOMPSON CIR
HOPE MILLS NC
28348-1930
US

V. Phone/Fax

Practice location:
  • Phone: 910-286-4784
  • Fax:
Mailing address:
  • Phone: 910-286-4784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number33389080
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: