Provider Demographics
NPI:1245787761
Name:HEATH, ASHLEIGH MARIE (LADC)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEIGH
Middle Name:MARIE
Last Name:HEATH
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05773-0207
Mailing Address - Country:US
Mailing Address - Phone:802-446-2640
Mailing Address - Fax:802-446-2636
Practice Address - Street 1:98 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:VT
Practice Address - Zip Code:05773
Practice Address - Country:US
Practice Address - Phone:802-446-2640
Practice Address - Fax:802-446-2636
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000721101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)