MEDICARE: ASHLEY THAXTON NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	679	WV

General Provider Information

NPI Number	:	1194423095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY THAXTON NCC

Provider Business Mailing Address
First Line	:	2406 KANAWHA BLVD E
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25311-2323
Country	:	US
Telephone Number	:	304-206-5528
Fax Number	:

Provider Business Practice Location Address
First Line	:	2406 KANAWHA BLVD E
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25311-2323
Country	:	US
Telephone Number	:	304-206-5528
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2023
Last Update Date	:	03/15/2026

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Directions to “ ASHLEY THAXTON NCC” Practice Location

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