Provider Demographics
NPI:1356793095
Name:BLANC, ASHLEY M (MA)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:M
Last Name:BLANC
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:M
Other - Last Name:BLEDSOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:WV
Mailing Address - Zip Code:26143-0609
Mailing Address - Country:US
Mailing Address - Phone:304-275-3301
Mailing Address - Fax:304-275-4798
Practice Address - Street 1:606 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RAVENSWOOD
Practice Address - State:WV
Practice Address - Zip Code:26164
Practice Address - Country:US
Practice Address - Phone:304-273-1033
Practice Address - Fax:304-273-1034
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1241103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1356793095Medicaid