Healthcare Provider Details

I. General information

NPI: 1093544751
Provider Name (Legal Business Name): ASHLEY HERNANDEZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY WILES

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 UNIVERSITY CITY BLVD
BLACKSBURG VA
24060-2706
US

IV. Provider business mailing address

700 UNIVERSITY CITY BLVD
BLACKSBURG VA
24060-2706
US

V. Phone/Fax

Practice location:
  • Phone: 540-961-8300
  • Fax: 540-961-8465
Mailing address:
  • Phone: 540-961-8300
  • Fax: 540-961-8465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701013570
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: