Provider Demographics
NPI:1932690682
Name:PETERSON, ASHLEY CAMILLE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CAMILLE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5680 KING CENTRE DR STE 600
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5755
Mailing Address - Country:US
Mailing Address - Phone:571-331-8842
Mailing Address - Fax:
Practice Address - Street 1:5680 KING CENTRE DR STE 600
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5755
Practice Address - Country:US
Practice Address - Phone:571-331-8842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC15046101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional