Healthcare Provider Details

I. General information

NPI: 1730554171
Provider Name (Legal Business Name): ASHLEY WIGHT LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY FREEMAN LCMHC

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 PINE ST
BURLINGTON VT
05401-5353
US

IV. Provider business mailing address

102 S WINOOSKI AVE STE 3J
BURLINGTON VT
05401-7406
US

V. Phone/Fax

Practice location:
  • Phone: 802-488-6000
  • Fax: 802-488-6919
Mailing address:
  • Phone: 802-488-6920
  • Fax: 802-488-6919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068-0108760
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: