Provider Demographics
NPI:1801079363
Name:STURDIVANT, ASHLEY BETH (LCPC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BETH
Last Name:STURDIVANT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6787 FLOWER HILL RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-6636
Mailing Address - Country:US
Mailing Address - Phone:816-674-2648
Mailing Address - Fax:
Practice Address - Street 1:6787 FLOWER HILL RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-6636
Practice Address - Country:US
Practice Address - Phone:816-674-2648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1869101YP2500X
IL180.014074101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional