=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265553747
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA G ASHLEY LCSW-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2007
-----------------------------------------------------
Last Update Date | 04/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30537 POTOMAC WAY SUITE 102
-----------------------------------------------------
City | CHARLOTTE HALL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20622-3179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-884-4225
-----------------------------------------------------
Fax | 301-884-2525
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30537 POTOMAC WAY SUITE 102
-----------------------------------------------------
City | CHARLOTTE HALL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20622-3179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-884-4225
-----------------------------------------------------
Fax | 301-884-2525
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 13055
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------