=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457817090
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSLYN L. ASHFORD LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2019
-----------------------------------------------------
Last Update Date | 02/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1515 PARKER DR
-----------------------------------------------------
City | LAUREL
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39440-1943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-307-3917
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 54 MATTIE DR
-----------------------------------------------------
City | ELLISVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39437-5147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-307-3917
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 2361
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------