Provider Demographics
NPI:1508623612
Name:CHILDS, ASHLEY (MED)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:CHILDS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:CHILDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2344 HANSEN LN UNIT 1
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-4884
Mailing Address - Country:US
Mailing Address - Phone:850-203-2441
Mailing Address - Fax:
Practice Address - Street 1:2344 HANSEN LN UNIT 1
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4884
Practice Address - Country:US
Practice Address - Phone:850-203-2441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH23656101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health