Healthcare Provider Details

I. General information

NPI: 1982071882
Provider Name (Legal Business Name): ASHLEY GOETSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 BILL FRANCE BLVD SUITE 200
DAYTONA BEACH FL
32114-1316
US

IV. Provider business mailing address

10 PINE BROOK DR
PALM COAST FL
32164-7052
US

V. Phone/Fax

Practice location:
  • Phone: 386-868-1992
  • Fax:
Mailing address:
  • Phone: 386-283-7476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: