Provider Demographics
NPI:1689437691
Name:MOORE CRUZ, ASHLEY (LPC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MOORE CRUZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 BRIDGE RD STE 8
Mailing Address - Street 2:PMB #260
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3361
Mailing Address - Country:US
Mailing Address - Phone:805-630-9734
Mailing Address - Fax:
Practice Address - Street 1:139 TILDEN AVE STE F
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3973
Practice Address - Country:US
Practice Address - Phone:760-751-9616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013267101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health