Provider Demographics
NPI:1457072332
Name:PEREZ, ASHLEY A
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:A
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44125 WOODRIDGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6839
Mailing Address - Country:US
Mailing Address - Phone:718-637-0233
Mailing Address - Fax:703-935-1366
Practice Address - Street 1:44125 WOODRIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-6839
Practice Address - Country:US
Practice Address - Phone:718-637-0233
Practice Address - Fax:703-935-1366
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA20-128585OtherREGISTERED BEHAVIOR TECHNICIAN