Provider Demographics
NPI:1487102885
Name:GREENLEAF, ASHLEY NEAL (LISW-CP, LAC, CAC II)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NEAL
Last Name:GREENLEAF
Suffix:
Gender:F
Credentials:LISW-CP, LAC, CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-3234
Mailing Address - Country:US
Mailing Address - Phone:864-707-2847
Mailing Address - Fax:
Practice Address - Street 1:187 W BROAD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3234
Practice Address - Country:US
Practice Address - Phone:864-707-2847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
SC11713104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAD10SPMedicaid