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General NPI Number Information
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NPI Number | 1285108472
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Entity Type | Individual
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Provider Name | ASHLEY ELIZABETH WADSWORTH MS, NCC, LCMHC-A
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Gender | Female
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Dates
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Enumeration Date | 01/22/2019
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Last Update Date | 04/08/2020
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Provider Practice Location Address
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Address Line | 231 MEMORIAL DR
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City | JACKSONVILLE
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State | NC
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Zip | 28546-6333
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Country | US
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Telephone | 910-353-5354
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Fax |
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Provider Business Mailing Address
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Address Line | 250 SEVILLE ST
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City | JACKSONVILLE
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State | NC
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Zip | 28546-8399
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Country | US
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Telephone | 401-654-0118
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A14581
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License Number State | NC
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