Provider Demographics
NPI:1760782775
Name:WILSON, ASHLEY E (LPC, LCPC)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:E
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPC, LCPC
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:E
Other - Last Name:FOULK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LCPC
Mailing Address - Street 1:775 RIBAUT RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5435
Mailing Address - Country:US
Mailing Address - Phone:202-329-6752
Mailing Address - Fax:
Practice Address - Street 1:775 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5435
Practice Address - Country:US
Practice Address - Phone:202-329-6752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5265101YP2500X
MDLC3790101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1760596480Medicaid