Provider Demographics
NPI:1336690791
Name:WHITE, ASHLEY D (LCSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:D
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6372 MECHANICSVILLE TPKE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-4705
Mailing Address - Country:US
Mailing Address - Phone:804-730-4690
Mailing Address - Fax:804-559-0333
Practice Address - Street 1:6372 MECHANICSVILLE TPKE
Practice Address - Street 2:SUITE 103
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-4705
Practice Address - Country:US
Practice Address - Phone:804-730-4690
Practice Address - Fax:804-559-0333
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040095581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05700OtherGROUP PTAN
VA9892OtherGROUP PTAN
VAC06115OtherGROUP PTAN