Provider Demographics
NPI:1598554255
Name:SMITH-WILLIS, ASHLEY D
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:D
Last Name:SMITH-WILLIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2542 GREENRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9410
Mailing Address - Country:US
Mailing Address - Phone:843-901-3370
Mailing Address - Fax:
Practice Address - Street 1:3445 INGLESIDE BLVD
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-4142
Practice Address - Country:US
Practice Address - Phone:843-901-3370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC177841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical