Provider Demographics
NPI:1043515174
Name:COMEGYS, ASHLEY CLARK (LCSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CLARK
Last Name:COMEGYS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:ELIZABETH
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:13194 US HIGHWAY 301 S UNIT 152
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-7410
Mailing Address - Country:US
Mailing Address - Phone:504-534-5636
Mailing Address - Fax:808-442-0429
Practice Address - Street 1:95-390 KUAHELANI AVE
Practice Address - Street 2:STE 3AC-1122
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-1192
Practice Address - Country:US
Practice Address - Phone:504-534-5636
Practice Address - Fax:808-442-0429
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11180104100000X, 1041C0700X
HI40751041C0700X
COCSW.099264201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI796906Medicaid