Provider Demographics
NPI:1578009221
Name:COCHRAN, ASHLEY LATRICE (LICSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LATRICE
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:LATRICE
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10100 ELIDA RD
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-9056
Mailing Address - Country:US
Mailing Address - Phone:419-695-8010
Mailing Address - Fax:419-695-0004
Practice Address - Street 1:9532 WYNLAKES PL
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8515
Practice Address - Country:US
Practice Address - Phone:334-270-3181
Practice Address - Fax:334-270-5805
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3943C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical