Provider Demographics
NPI:1952844193
Name:ROBERSON, ASHLEY LYNN
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:LYNN
Last Name:ROBERSON
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:PO BOX 1284
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20725-1284
Mailing Address - Country:US
Mailing Address - Phone:225-772-5059
Mailing Address - Fax:
Practice Address - Street 1:7610 PENNSYLVANIA AVE STE 203
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:MD
Practice Address - Zip Code:20747
Practice Address - Country:US
Practice Address - Phone:301-420-1972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-20
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500810471041C0700X
MD20787104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical