Provider Demographics
NPI:1699539585
Name:BURLESON, ASHTON (MSW)
Entity type:Individual
Prefix:
First Name:ASHTON
Middle Name:
Last Name:BURLESON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3122 VASHTI RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-6828
Mailing Address - Country:US
Mailing Address - Phone:803-908-9251
Mailing Address - Fax:
Practice Address - Street 1:3122 VASHTI RD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-6828
Practice Address - Country:US
Practice Address - Phone:803-908-9251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0216631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical