Provider Demographics
NPI:1922515816
Name:ERVIN, ASHLEY (LCDC, III)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:ERVIN
Suffix:
Gender:F
Credentials:LCDC, III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 W GAMBIER ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-2421
Mailing Address - Country:US
Mailing Address - Phone:740-326-9099
Mailing Address - Fax:
Practice Address - Street 1:113 W GAMBIER ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-2421
Practice Address - Country:US
Practice Address - Phone:740-326-9099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH162596101YA0400X
CDCA.166102101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)