Healthcare Provider Details

I. General information

NPI: 1326348863
Provider Name (Legal Business Name): DAWN CHARISSE ASHLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WURTZBURGER LANDSTR 24
ANSBACH BAVARIA
91522
DE

IV. Provider business mailing address

WURTZBURGER LANDSTR 24
ANSBACH BAVARIA
91522
DE

V. Phone/Fax

Practice location:
  • Phone: 224-500-4714
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 9787
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: