Healthcare Provider Details

I. General information

NPI: 1336690791
Provider Name (Legal Business Name): ASHLEY D WHITE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6372 MECHANICSVILLE TPKE SUITE 103
MECHANICSVILLE VA
23111-4705
US

IV. Provider business mailing address

6372 MECHANICSVILLE TPKE SUITE 103
MECHANICSVILLE VA
23111-4705
US

V. Phone/Fax

Practice location:
  • Phone: 804-730-4690
  • Fax: 804-559-0333
Mailing address:
  • Phone: 804-730-4690
  • Fax: 804-559-0333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904009558
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: