Provider Demographics
NPI:1316597388
Name:ASHELFORD, LETICIA ISABEL
Entity Type:Individual
Prefix:MS
First Name:LETICIA
Middle Name:ISABEL
Last Name:ASHELFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 TORRANCE BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5805
Mailing Address - Country:US
Mailing Address - Phone:310-787-1335
Mailing Address - Fax:310-787-1809
Practice Address - Street 1:3440 TORRANCE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5805
Practice Address - Country:US
Practice Address - Phone:310-787-1335
Practice Address - Fax:310-787-1809
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13166-R101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)