Healthcare Provider Details

I. General information

NPI: 1811827710
Provider Name (Legal Business Name): ASHLEY BASTRON LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2499 HENNING DR
WINSTON SALEM NC
27106-4558
US

IV. Provider business mailing address

909 WALNUT ST
WINSTON SALEM NC
27101-5738
US

V. Phone/Fax

Practice location:
  • Phone: 336-298-8032
  • Fax:
Mailing address:
  • Phone: 616-308-3831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22932
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: