Provider Demographics
NPI:1437654233
Name:DOERGE, ASHLEY (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:DOERGE
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11233 STATE ROUTE 13
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:IL
Mailing Address - Zip Code:62286-3027
Mailing Address - Country:US
Mailing Address - Phone:618-598-6040
Mailing Address - Fax:618-615-4151
Practice Address - Street 1:11233 STATE ROUTE 13
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:IL
Practice Address - Zip Code:62286-3027
Practice Address - Country:US
Practice Address - Phone:618-598-6040
Practice Address - Fax:618-615-4151
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.012322101YP2500X
IL00145643225C00000X
IL32972101YA0400X
IL180013182101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)