Provider Demographics
NPI:1033985221
Name:CARRUBBA, ASHLEY (ACMHC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:CARRUBBA
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 E MAIN ST STE G
Mailing Address - Street 2:
Mailing Address - City:GRANTSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84029-2501
Mailing Address - Country:US
Mailing Address - Phone:435-850-0034
Mailing Address - Fax:
Practice Address - Street 1:822 E MAIN ST STE G
Practice Address - Street 2:
Practice Address - City:GRANTSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84029-2501
Practice Address - Country:US
Practice Address - Phone:435-850-0034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13555110-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health