Provider Demographics
NPI:1588428478
Name:ASHFORD, AUBREY G JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:AUBREY
Middle Name:G
Last Name:ASHFORD
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4556 JACKAM RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-6280
Mailing Address - Country:US
Mailing Address - Phone:404-384-5852
Mailing Address - Fax:
Practice Address - Street 1:4556 JACKAM RIDGE CT
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-6280
Practice Address - Country:US
Practice Address - Phone:404-384-5852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW008806101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health