MEDICARE: ASHLEY HARRIS WHITFIELD LPC

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	101Y00000X	Counselor	LPC009757	GA
2	101Y00000X	Counselor	2571	MS
3	101YM0800X	Mental Health Counselor	2571	MS
4	101YM0800X	Mental Health Counselor	LPC009757	GA
5	101YP2500X	Professional Counselor	LPC009757	GA
6	101YP2500X	Professional Counselor	2571	MS

General Provider Information

NPI Number	:	1326564220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY HARRIS WHITFIELD LPC

Provider Business Mailing Address
First Line	:	951 CLEVELAND AVE
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39507-3330
Country	:	US
Telephone Number	:	404-663-7822
Fax Number	:

Provider Business Practice Location Address
First Line	:	951 CLEVELAND AVE
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39507-3330
Country	:	US
Telephone Number	:	404-663-7822
Fax Number	:

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

Provider Enumeration Date	:	08/22/2017
Last Update Date	:	03/23/2020

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