Healthcare Provider Details

I. General information

NPI: 1598380933
Provider Name (Legal Business Name): MRS. ASHLEY SERAFINA FRIEND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BIG TREES ROAD SUITE D
MURPHYS CA
95247
US

IV. Provider business mailing address

PO BOX 1987
DIAMOND SPRINGS CA
95619
US

V. Phone/Fax

Practice location:
  • Phone: 209-770-6877
  • Fax:
Mailing address:
  • Phone: 209-559-6314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW106453
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: