Provider Demographics
NPI:1285902239
Name:KERNODLE, ASHLEY A (QP, MSW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:A
Last Name:KERNODLE
Suffix:
Gender:F
Credentials:QP, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CAPITOLA DR STE 310
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4497
Mailing Address - Country:US
Mailing Address - Phone:919-474-6400
Mailing Address - Fax:919-474-6401
Practice Address - Street 1:100 CAPITOLA DR STE 310
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-4497
Practice Address - Country:US
Practice Address - Phone:919-474-6400
Practice Address - Fax:919-474-6401
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health