Healthcare Provider Details

I. General information

NPI: 1457284754
Provider Name (Legal Business Name): ASHLEY VELASQUEZ MA, LAPC, NCC, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 S MAIN ST STE 103
PITTSTON PA
18640-1702
US

IV. Provider business mailing address

49 S MAIN ST STE 103
PITTSTON PA
18640-1702
US

V. Phone/Fax

Practice location:
  • Phone: 570-212-9866
  • Fax:
Mailing address:
  • Phone: 570-212-9866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC001631
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAPC001631
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC001631
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: