Provider Demographics
NPI:1790539237
Name:HARRELL, ASHLEY B (MA, MCAP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:B
Last Name:HARRELL
Suffix:
Gender:F
Credentials:MA, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 20TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-3563
Mailing Address - Country:US
Mailing Address - Phone:772-770-4811
Mailing Address - Fax:
Practice Address - Street 1:1507 20TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3563
Practice Address - Country:US
Practice Address - Phone:772-770-4811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMCAP0101080101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)