Individual
ASHTON DOBY TISDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW-CP, LAC, AADC
Contact information
Practice address
1224 PICKENS ST STE 220, COLUMBIA, SC 29201-3428
(803) 875-1699
Mailing address
1461 HEINS RD, BLYTHEWOOD, SC 29016-8922
(803) 875-1699
(803) 728-3047
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
10820
SC
1041C0700X
Clinical Social Worker
Primary
10820
SC
Other
Enumeration date
02/15/2018
Last updated
07/27/2021
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