Healthcare Provider Details

I. General information

NPI: 1295361541
Provider Name (Legal Business Name): ASHLEY ANALICIA BEDEAU LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 BRIGHTSEAT RD STE 210
HYATTSVILLE MD
20785-4736
US

IV. Provider business mailing address

337 BRIGHTSEAT RD STE 210
HYATTSVILLE MD
20785-4736
US

V. Phone/Fax

Practice location:
  • Phone: 301-429-8950
  • Fax:
Mailing address:
  • Phone: 301-429-8950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP9401
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC11394
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: