Provider Demographics
NPI:1205236460
Name:PHELPS, ASHLEY NICOLE (MA LPA, HSP-PA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICOLE
Last Name:PHELPS
Suffix:
Gender:F
Credentials:MA LPA, HSP-PA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:NICOLE
Other - Last Name:AIKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPA, HSP-PA
Mailing Address - Street 1:1500 PADSTONE DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-6520
Mailing Address - Country:US
Mailing Address - Phone:214-649-6356
Mailing Address - Fax:
Practice Address - Street 1:315 S SALEM ST STE 228
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-1863
Practice Address - Country:US
Practice Address - Phone:919-249-8053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4549103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical