Healthcare Provider Details

I. General information

NPI: 1225657463
Provider Name (Legal Business Name): ASHLEY CARROLL TUTTLE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17579 WARWICK BLVD
NEWPORT NEWS VA
23603-1343
US

IV. Provider business mailing address

17579 WARWICK BLVD
NEWPORT NEWS VA
23603-1343
US

V. Phone/Fax

Practice location:
  • Phone: 757-888-0400
  • Fax:
Mailing address:
  • Phone: 757-888-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701009034
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: