Healthcare Provider Details

I. General information

NPI: 1194297283
Provider Name (Legal Business Name): HOLLY ASHLEY LICSW, LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2018
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6710 OXON HILL RD STE 210
OXON HILL MD
20745-1124
US

IV. Provider business mailing address

6710 OXON HILL RD STE 210
OXON HILL MD
20745-1124
US

V. Phone/Fax

Practice location:
  • Phone: 202-607-4543
  • Fax:
Mailing address:
  • Phone: 202-607-4543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number24052
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number24052
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC200001260
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: