Provider Demographics
NPI:1922336023
Name:NETTERLUND, ASHLEY (MA, LPC)
Entity Type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:
Last Name:NETTERLUND
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 PERIMETER PARK DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341
Mailing Address - Country:US
Mailing Address - Phone:770-457-5577
Mailing Address - Fax:770-457-5599
Practice Address - Street 1:2308 PERIMETER PARK DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341
Practice Address - Country:US
Practice Address - Phone:770-457-5577
Practice Address - Fax:770-457-5599
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
KYKY-0895103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical