Healthcare Provider Details

I. General information

NPI: 1093169989
Provider Name (Legal Business Name): ASHLEY A WORMLEY MS, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3095 KETTERING BLVD
MORAINE OH
45439-1983
US

IV. Provider business mailing address

3095 KETTERING BLVD
MORAINE OH
45439-1983
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-8300
  • Fax:
Mailing address:
  • Phone: 937-293-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2001686
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01101800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC16815
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20668
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC019020
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: