Provider Demographics
NPI:1265553747
Name:ASHLEY, LAURA G (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:G
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30537 POTOMAC WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHARLOTTE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:20622-3179
Mailing Address - Country:US
Mailing Address - Phone:301-884-4225
Mailing Address - Fax:301-884-2525
Practice Address - Street 1:30537 POTOMAC WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTE HALL
Practice Address - State:MD
Practice Address - Zip Code:20622-3179
Practice Address - Country:US
Practice Address - Phone:301-884-4225
Practice Address - Fax:301-884-2525
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD130551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD58956180Medicaid
MD58956180Medicaid