Provider Demographics
NPI:1689908386
Name:HARROLD, ASHLEY RENEE (LMHC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RENEE
Last Name:HARROLD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:RENEE
Other - Last Name:GRIMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:390 16TH AVE S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-4961
Mailing Address - Country:US
Mailing Address - Phone:904-717-7996
Mailing Address - Fax:
Practice Address - Street 1:4205 BELFORT RD STE 4030
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1475
Practice Address - Country:US
Practice Address - Phone:904-450-7070
Practice Address - Fax:904-450-7089
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
FLMH13266101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No171W00000XOther Service ProvidersContractorGroup - Single Specialty