Provider Demographics
NPI:1801233770
Name:NEAL SULLIVAN, ASHLEY NICOLE N (LCSW)
Entity type:Individual
Prefix:
First Name:ASHLEY NICOLE
Middle Name:N
Last Name:NEAL SULLIVAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ASHLEY NICOLE
Other - Middle Name:WOLFE
Other - Last Name:NEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:306 NICODEMUS RD
Mailing Address - Street 2:
Mailing Address - City:GLYNDON
Mailing Address - State:MD
Mailing Address - Zip Code:21136-3229
Mailing Address - Country:US
Mailing Address - Phone:703-371-8744
Mailing Address - Fax:
Practice Address - Street 1:306 NICODEMUS RD
Practice Address - Street 2:
Practice Address - City:GLYNDON
Practice Address - State:MD
Practice Address - Zip Code:21136-3229
Practice Address - Country:US
Practice Address - Phone:703-371-8744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2021-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040081531041C0700X
MD264121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA04945247Medicaid