Provider Demographics
NPI:1710646104
Name:ASHLEY, ISABELLA CHEREE (ALC)
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:CHEREE
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HIGHWAY 78 W
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-3655
Mailing Address - Country:US
Mailing Address - Phone:205-300-8318
Mailing Address - Fax:844-269-8087
Practice Address - Street 1:415 HORSE CREEK BLVD
Practice Address - Street 2:
Practice Address - City:DORA
Practice Address - State:AL
Practice Address - Zip Code:35062-5238
Practice Address - Country:US
Practice Address - Phone:205-544-5892
Practice Address - Fax:844-269-8087
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3940A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional