Healthcare Provider Details

I. General information

NPI: 1295666907
Provider Name (Legal Business Name): ASHLEY LANDRUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 OLD RIVERSIDE DR
DANVILLE VA
24541-3454
US

IV. Provider business mailing address

705 MAIN ST
DANVILLE VA
24541-1803
US

V. Phone/Fax

Practice location:
  • Phone: 434-791-4793
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701016194
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: