Provider Demographics
NPI:1689251084
Name:GRIDER, ASHLEY J (BA, CDCA)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:J
Last Name:GRIDER
Suffix:
Gender:F
Credentials:BA, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-8113
Mailing Address - Country:US
Mailing Address - Phone:419-576-1225
Mailing Address - Fax:419-379-0366
Practice Address - Street 1:923 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-8113
Practice Address - Country:US
Practice Address - Phone:419-576-1225
Practice Address - Fax:419-379-0366
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.174562101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)