Healthcare Provider Details

I. General information

NPI: 1669337861
Provider Name (Legal Business Name): ASHLIN CARRANZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 WORTH AVE # 1073
STAFFORD VA
22556-1596
US

IV. Provider business mailing address

295 WORTH AVE # 1073
STAFFORD VA
22556-1596
US

V. Phone/Fax

Practice location:
  • Phone: 540-251-9664
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-462325
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: