=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033705710
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASHLEY PATRICAN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2020
-----------------------------------------------------
Last Update Date | 12/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4343A RIDGEWOOD CENTER DR
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22192-5308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-897-8970
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4343A RIDGEWOOD CENTER DR
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22192-5308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-873-4350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ASHLEY ELIZABETH PATRICAN
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 202-873-4350
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------