Provider Demographics
NPI:1164079257
Name:EASTERLY, ASHLEY ANN (CDCA 1)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ANN
Last Name:EASTERLY
Suffix:
Gender:F
Credentials:CDCA 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 E 6TH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-2556
Mailing Address - Country:US
Mailing Address - Phone:513-433-9517
Mailing Address - Fax:
Practice Address - Street 1:165 E 6TH ST APT 6
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-2556
Practice Address - Country:US
Practice Address - Phone:513-433-9517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171196101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty