Provider Demographics
NPI:1255716593
Name:ELLISON, ASHLEY (LMSW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:ELLISON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CANDLEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-9701
Mailing Address - Country:US
Mailing Address - Phone:910-797-0449
Mailing Address - Fax:
Practice Address - Street 1:14 CANDLEBERRY DR
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-9701
Practice Address - Country:US
Practice Address - Phone:910-797-0449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD31134104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker