Provider Demographics
NPI:1104179605
Name:ASHBY, ANGELA RAY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:RAY
Last Name:ASHBY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:R
Other - Last Name:WINNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:1830 MCCOMB ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-3137
Mailing Address - Country:US
Mailing Address - Phone:217-273-6157
Mailing Address - Fax:
Practice Address - Street 1:119 N PINE ST
Practice Address - Street 2:
Practice Address - City:HAZEL DELL
Practice Address - State:IL
Practice Address - Zip Code:62428-2017
Practice Address - Country:US
Practice Address - Phone:217-273-6157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009941101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional