Provider Demographics
NPI:1770757296
Name:ASHWORTH, RICHARD J (LCSW)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:ASHWORTH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 HAWKSBILL LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1468
Mailing Address - Country:US
Mailing Address - Phone:757-696-3424
Mailing Address - Fax:757-648-8780
Practice Address - Street 1:2202 EXECUTIVE DR
Practice Address - Street 2:SUITE C
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6604
Practice Address - Country:US
Practice Address - Phone:757-827-7707
Practice Address - Fax:757-838-2573
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040005311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA356288OtherBLUE CROSS BLUE SHIELD
VAMC11570Medicare PIN