Provider Demographics
NPI:1164838660
Name:LAVINE, ASHLEY L
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:L
Last Name:LAVINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLE
Other - Middle Name:L
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1271
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-1271
Mailing Address - Country:US
Mailing Address - Phone:214-284-5220
Mailing Address - Fax:
Practice Address - Street 1:2503 PINE ST STE 4
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-4368
Practice Address - Country:US
Practice Address - Phone:940-641-6768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1804037101YM0800X
TX92419101YM0800X
171M00000X
ARP2111004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator