Healthcare Provider Details

I. General information

NPI: 1649563081
Provider Name (Legal Business Name): TIFFANI ASHLAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8767 SEMINOLE TRL STE 201A
RUCKERSVILLE VA
22968
US

IV. Provider business mailing address

8767 SEMINOLE TRL STE 201A
RUCKERSVILLE VA
22968-3494
US

V. Phone/Fax

Practice location:
  • Phone: 434-990-0110
  • Fax:
Mailing address:
  • Phone: 434-990-0110
  • Fax: 434-990-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904007616
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: