Healthcare Provider Details

I. General information

NPI: 1255255196
Provider Name (Legal Business Name): ASHLEY AYALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MONTGOMERY VILLAGE AVE STE 410
GAITHERSBURG MD
20879-3557
US

IV. Provider business mailing address

1131 MAIN ST
GAITHERSBURG MD
20878-5582
US

V. Phone/Fax

Practice location:
  • Phone: 240-801-9818
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP17972
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: