Provider Demographics
NPI:1487206405
Name:MCCUTCHEON, ASHLEY DAWN
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DAWN
Last Name:MCCUTCHEON
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 1:304 PRATT CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1861
Mailing Address - Country:US
Mailing Address - Phone:757-818-0719
Mailing Address - Fax:
Practice Address - Street 1:4453 SHORE DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-2821
Practice Address - Country:US
Practice Address - Phone:757-231-6343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704008547101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health