=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932238532
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEY BRATCHER LISW-CP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2007
-----------------------------------------------------
Last Update Date | 06/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26 HEARTWOOD CT
-----------------------------------------------------
City | BLUFFTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29910-9560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-321-7107
-----------------------------------------------------
Fax | 843-326-4806
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 198 OKATIE VILLAGE DR STE 103-332
-----------------------------------------------------
City | OKATIE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29909-7527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-321-7107
-----------------------------------------------------
Fax | 843-326-4806
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 9402
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------