Provider Demographics
NPI:1134881352
Name:TISON, ASHLEY E (LCPC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:E
Last Name:TISON
Suffix:
Gender:F
Credentials:LCPC
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 302
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:ME
Mailing Address - Zip Code:04640-0302
Mailing Address - Country:US
Mailing Address - Phone:207-477-7100
Mailing Address - Fax:
Practice Address - Street 1:1405 US HWY 1
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:ME
Practice Address - Zip Code:04640-3463
Practice Address - Country:US
Practice Address - Phone:207-477-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2024-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC7326101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor