Provider Demographics
NPI:1174176341
Name:MARTIN, ASHLEY DEON (MSW, MHA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DEON
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSW, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N HARVIN ST FL 3
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4956
Mailing Address - Country:US
Mailing Address - Phone:803-775-6815
Mailing Address - Fax:803-773-6232
Practice Address - Street 1:115 N HARVIN ST FL 3
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4956
Practice Address - Country:US
Practice Address - Phone:803-775-6815
Practice Address - Fax:803-773-6232
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor