Provider Demographics
NPI:1912655119
Name:BRICKHOUSE, ASHLEY CHANTELLE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CHANTELLE
Last Name:BRICKHOUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-3531
Mailing Address - Country:US
Mailing Address - Phone:757-337-7396
Mailing Address - Fax:
Practice Address - Street 1:733 MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-3531
Practice Address - Country:US
Practice Address - Phone:757-337-7396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3900251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services