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NPI Code Detail

MEDICARE: ASHLEY PETTWAY LPC

MEDICARE: ASHLEY PETTWAY 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
1101YP2500XProfessional CounselorGA

General Provider Information

NPI Number : 1811683469
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY PETTWAY LPC
Provider Business Mailing Address
First Line : 4300 PACES FERRY RD SE STE 500
Second Line :
City : ATLANTA
State : GA
Zip : 30339-5714
Country : US
Telephone Number : 404-981-5163
Fax Number :
Provider Business Practice Location Address
First Line : 4300 PACES FERRY RD SE STE 500
Second Line :
City : ATLANTA
State : GA
Zip : 30339-5714
Country : US
Telephone Number : 404-981-5163
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2023
Last Update Date : 03/05/2026

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Directions to “ ASHLEY PETTWAY LPC” Practice Location

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