Provider Demographics
NPI:1336603091
Name:SANTANA, ASHLEY (LPCMH, DVS)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:
Last Name:SANTANA
Suffix:
Gender:F
Credentials:LPCMH, DVS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 THERESA WAY
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:DE
Mailing Address - Zip Code:19962
Mailing Address - Country:US
Mailing Address - Phone:302-531-6760
Mailing Address - Fax:
Practice Address - Street 1:32 WEST LOOKERMAN STREET
Practice Address - Street 2:SUITE #103
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904
Practice Address - Country:US
Practice Address - Phone:302-422-3811
Practice Address - Fax:302-351-8699
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000779101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health