Provider Demographics
NPI:1497142327
Name:CONGDON, ASHLEY (LADC)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:CONGDON
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06280-1040
Mailing Address - Country:US
Mailing Address - Phone:860-377-6324
Mailing Address - Fax:
Practice Address - Street 1:19 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:CT
Practice Address - Zip Code:06280-1040
Practice Address - Country:US
Practice Address - Phone:860-377-6324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT44.001135101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)