Provider Demographics
NPI:1467150409
Name:ASHLEY, JESSICA COURTNEY
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:COURTNEY
Last Name:ASHLEY
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 1:102 E HICKS ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23868-1830
Mailing Address - Country:US
Mailing Address - Phone:434-532-8214
Mailing Address - Fax:434-532-8215
Practice Address - Street 1:102 E HICKS ST STE 200
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:VA
Practice Address - Zip Code:23868-1830
Practice Address - Country:US
Practice Address - Phone:434-532-8214
Practice Address - Fax:434-532-8215
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health