Provider Demographics
NPI:1437640737
Name:DEHERRERA, ASHLEE GABRIAL (CCAPP REG INTERN)
Entity Type:Individual
Prefix:
First Name:ASHLEE
Middle Name:GABRIAL
Last Name:DEHERRERA
Suffix:
Gender:F
Credentials:CCAPP REG INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 6TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-3834
Mailing Address - Country:US
Mailing Address - Phone:831-265-7317
Mailing Address - Fax:
Practice Address - Street 1:335 6TH ST
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-3834
Practice Address - Country:US
Practice Address - Phone:831-265-7317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATBA-0000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATBA-0000OtherCCAPP REG INTERN