Provider Demographics
NPI:1164256590
Name:DINKINS, ASHLEY DOMINIQUE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DOMINIQUE
Last Name:DINKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 SUPERIOR DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-3190
Mailing Address - Country:US
Mailing Address - Phone:910-484-1722
Mailing Address - Fax:
Practice Address - Street 1:102 SUPERIOR DR
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-3190
Practice Address - Country:US
Practice Address - Phone:910-484-1722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst