Healthcare Provider Details

I. General information

NPI: 1235528993
Provider Name (Legal Business Name): STACEY ASH LSW, CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43637 CAMERON RD
WELLSVILLE OH
43968-9734
US

IV. Provider business mailing address

43637 CAMERON RD
WELLSVILLE OH
43968-9734
US

V. Phone/Fax

Practice location:
  • Phone: 330-532-9087
  • Fax:
Mailing address:
  • Phone: 330-532-9087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number080302
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS1303314
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: