Provider Demographics
NPI:1427227123
Name:HALL, ASHLEY NICOLE (LCSW, CADAC-IV)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICOLE
Last Name:HALL
Suffix:
Gender:F
Credentials:LCSW, CADAC-IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 WASHBURN AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4725
Mailing Address - Country:US
Mailing Address - Phone:502-386-8698
Mailing Address - Fax:502-653-7417
Practice Address - Street 1:501 WASHBURN AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4725
Practice Address - Country:US
Practice Address - Phone:502-386-8698
Practice Address - Fax:502-653-7417
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33005393A1041C0700X
KY33871041C0700X
INCIV-1405101YA0400X
INCCDP-D-58101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)