MEDICARE: COREY ASHMORE LCSW

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	1041C0700X	Clinical Social Worker	CSW007963	GA

General Provider Information

NPI Number	:	1750025722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY ASHMORE LCSW

Provider Business Mailing Address
First Line	:	40 PEACHTREE VALLEY RD NE APT 2507
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-8017
Country	:	US
Telephone Number	:	609-284-4537
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 PEACHTREE VALLEY RD NE APT 2507
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-8017
Country	:	US
Telephone Number	:	609-284-4537
Fax Number	:

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

Provider Enumeration Date	:	04/25/2022
Last Update Date	:	04/25/2022

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Directions to “ COREY ASHMORE LCSW” Practice Location

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