Provider Demographics
NPI:1922511625
Name:PHELPS, ASHLEY N (LICSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:N
Last Name:PHELPS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 PROVIDENCE MAIN ST NW UNIT 200
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-4917
Mailing Address - Country:US
Mailing Address - Phone:256-517-7009
Mailing Address - Fax:
Practice Address - Street 1:220 PROVIDENCE MAIN ST NW UNIT 200
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-4917
Practice Address - Country:US
Practice Address - Phone:256-325-1556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4313C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical