Provider Demographics
NPI:1457817090
Name:ASHFORD, ROSLYN L (LPC)
Entity Type:Individual
Prefix:DR
First Name:ROSLYN
Middle Name:L
Last Name:ASHFORD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 MATTIE DR
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39437-5147
Mailing Address - Country:US
Mailing Address - Phone:601-307-3917
Mailing Address - Fax:
Practice Address - Street 1:1515 PARKER DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-1943
Practice Address - Country:US
Practice Address - Phone:601-307-3917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2361101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional