Provider Demographics
NPI:1720416969
Name:PENNEWILL, ASHLEY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ASHLEY
Middle Name:
Last Name:PENNEWILL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 E WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-4354
Mailing Address - Country:US
Mailing Address - Phone:850-501-5110
Mailing Address - Fax:850-254-1973
Practice Address - Street 1:605 E GOVERNMENT ST
Practice Address - Street 2:STE C
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-8104
Practice Address - Country:US
Practice Address - Phone:850-501-5110
Practice Address - Fax:850-254-1973
Is Sole Proprietor?:No
Enumeration Date:2013-10-25
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW116081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical