Provider Demographics
NPI:1013497544
Name:MORGAN, ASHLEY MIA (LCSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MIA
Last Name:MORGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3438 MENDOCINO AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2275
Mailing Address - Country:US
Mailing Address - Phone:707-387-4525
Mailing Address - Fax:707-703-5794
Practice Address - Street 1:3438 MENDOCINO AVE STE B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2275
Practice Address - Country:US
Practice Address - Phone:707-387-4525
Practice Address - Fax:707-861-9292
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2023-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104100000X
CA903701041C0700X
CA1162361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker