Provider Demographics
NPI:1053992230
Name:CONNER, ASHANTI COURTNEY (LPC)
Entity type:Individual
Prefix:MRS
First Name:ASHANTI
Middle Name:COURTNEY
Last Name:CONNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 FAIRFAX DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-1840
Mailing Address - Country:US
Mailing Address - Phone:757-470-0572
Mailing Address - Fax:
Practice Address - Street 1:7025 HARBOUR VIEW BLVD STE 119
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2762
Practice Address - Country:US
Practice Address - Phone:757-274-2836
Practice Address - Fax:757-673-2586
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010436101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional