Provider Demographics
NPI:1386151744
Name:WHITE, ASHLEY (CACP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:CACP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:MAKINSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:306 AIRPORT DR
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-2629
Mailing Address - Country:US
Mailing Address - Phone:843-761-8272
Mailing Address - Fax:
Practice Address - Street 1:306 AIRPORT DR
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-2629
Practice Address - Country:US
Practice Address - Phone:843-761-8272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1972574101Medicaid