1386926558 NPI number — TAMARA STEBLEZ ASHLEY M.S., LPC, NCC

Table of content: TAMARA STEBLEZ ASHLEY M.S., LPC, NCC (NPI 1386926558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386926558 NPI number — TAMARA STEBLEZ ASHLEY M.S., LPC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ASHLEY
Provider First Name:
TAMARA
Provider Middle Name:
STEBLEZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., LPC, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEBLEZ
Provider Other First Name:
TAMARA
Provider Other Middle Name:
JOAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., LPC, NCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386926558
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3050 FIVE FORKS TRICKUM RD SW
Provider Second Line Business Mailing Address:
D545
Provider Business Mailing Address City Name:
LILBURN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30047-1810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-458-7219
Provider Business Mailing Address Fax Number:
404-869-6177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 LENOX POINTE NE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30324-7415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-458-7219
Provider Business Practice Location Address Fax Number:
404-869-6177
Provider Enumeration Date:
09/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC007878 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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