Provider Demographics
NPI:1679956676
Name:HOLBERT, ASHLEY (PHD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:HOLBERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3469 FORTUNA DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-5281
Mailing Address - Country:US
Mailing Address - Phone:330-644-3469
Mailing Address - Fax:330-644-8519
Practice Address - Street 1:3469 FORTUNA DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-5281
Practice Address - Country:US
Practice Address - Phone:330-644-3469
Practice Address - Fax:330-644-8519
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7309103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341757672OtherEIN