Provider Demographics
NPI:1780313494
Name:BURGESS, ASHLEY MICHELE (LCSW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MICHELE
Last Name:BURGESS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 SEMMES AVE APT B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-3851
Mailing Address - Country:US
Mailing Address - Phone:540-907-7186
Mailing Address - Fax:
Practice Address - Street 1:2501 SEMMES AVE APT B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-3851
Practice Address - Country:US
Practice Address - Phone:540-907-7186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040140591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical