Provider Demographics
NPI:1760787196
Name:ASHTON, MELINDA (LCSW)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:ASHTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-1301
Mailing Address - Country:US
Mailing Address - Phone:703-549-7295
Mailing Address - Fax:
Practice Address - Street 1:8320 PROFESSIONAL HILL DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4611
Practice Address - Country:US
Practice Address - Phone:703-876-8480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-15
Last Update Date:2011-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040019811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical