Provider Demographics
NPI:1215814140
Name:ASHWORTH, HEAVEN LEKAY
Entity type:Individual
Prefix:
First Name:HEAVEN
Middle Name:LEKAY
Last Name:ASHWORTH
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 1:100 COMMERCE DR UNIT 452
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-8020
Mailing Address - Country:US
Mailing Address - Phone:404-590-1677
Mailing Address - Fax:
Practice Address - Street 1:100 COMMERCE DR STE 452100
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-8001
Practice Address - Country:US
Practice Address - Phone:404-590-1677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-23-259071103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst