Provider Demographics
NPI:1376157818
Name:EWING, ASHLEY
Entity Type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:
Last Name:EWING
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 1:1810 STATE ST APT 203
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2807
Mailing Address - Country:US
Mailing Address - Phone:520-955-3455
Mailing Address - Fax:
Practice Address - Street 1:4025 CAMINO DEL RIO S # 250A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4107
Practice Address - Country:US
Practice Address - Phone:619-858-3101
Practice Address - Fax:619-280-5420
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC4080101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health