Provider Demographics
NPI:1780376475
Name:ASHLEY WISE THERAPY LLC
Entity type:Organization
Organization Name:ASHLEY WISE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:567-242-4123
Mailing Address - Street 1:391 WHITFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-1502
Mailing Address - Country:US
Mailing Address - Phone:567-242-4123
Mailing Address - Fax:
Practice Address - Street 1:9015 TOWN CENTER PKWY UNIT 129
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5305
Practice Address - Country:US
Practice Address - Phone:941-404-5480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty