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General NPI Number Information
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NPI Number | 1114165651
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Entity Type | Individual
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Provider Name | RYAN ASHLEY LMSW, CAADC
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Gender | Male
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Dates
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Enumeration Date | 01/21/2009
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Last Update Date | 11/10/2020
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Provider Practice Location Address
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Address Line | 1685 BALDWIN AVE
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City | PONTIAC
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State | MI
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Zip | 48340-1115
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Country | US
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Telephone | 248-706-3450
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Fax |
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Provider Business Mailing Address
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Address Line | 1685 BALDWIN AVE
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City | PONTIAC
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State | MI
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Zip | 48340-1115
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Country | US
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Telephone | 248-706-3450
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | C-01071
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801090193
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License Number State | MI
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