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General NPI Number Information
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NPI Number | 1427565209
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Entity Type | Organization
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Legal Business Name | ASHTON DALE COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 01/03/2018
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Last Update Date | 01/03/2018
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Provider Practice Location Address
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Address Line | 400 FAIRHOPE AVE STE 2A
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City | FAIRHOPE
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State | AL
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Zip | 36532-2126
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Country | US
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Telephone | 251-421-3550
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Fax |
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Provider Business Mailing Address
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Address Line | 20637 BLUEBERRY LN UNIT 26
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City | FAIRHOPE
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State | AL
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Zip | 36532-7279
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Country | US
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Telephone | 251-421-3550
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ASHTON E DALE
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Credential | LPC, CAC
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Telephone | 251-421-3550
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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 | 1172
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2106
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License Number State | AL
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