Provider Demographics
NPI:1528802139
Name:DECAMP, ASHLEY (ED S)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:DECAMP
Suffix:
Gender:F
Credentials:ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 WIDE RIVER DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7626
Mailing Address - Country:US
Mailing Address - Phone:602-318-2571
Mailing Address - Fax:
Practice Address - Street 1:2315 WIDE RIVER DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7626
Practice Address - Country:US
Practice Address - Phone:602-318-2571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool