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General NPI Number Information
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NPI Number | 1437868940
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Entity Type | Organization
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Legal Business Name | ASHLEY DOERGE
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Dates
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Enumeration Date | 11/23/2022
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 11233 STATE ROUTE 13
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City | SPARTA
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State | IL
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Zip | 62286-3027
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Country | US
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Telephone | 618-598-6040
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Fax | 618-615-4151
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Provider Business Mailing Address
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Address Line | 11233 STATE ROUTE 13
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City | SPARTA
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State | IL
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Zip | 62286-3027
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Country | US
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Telephone | 618-598-6040
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Fax | 618-615-4151
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | ASHLEY DOERGE
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Credential | MS, LCPC
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Telephone | 618-598-6040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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