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General NPI Number Information
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NPI Number | 1699432864
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Entity Type | Individual
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Provider Name | ASHALEE RENE UTZ LCSW, SOTP-TRAINEE
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Gender | Female
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Dates
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Enumeration Date | 11/23/2021
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Last Update Date | 11/23/2021
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Provider Practice Location Address
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Address Line | 109.5 CLAY ST
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City | SUFFOLK
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State | VA
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Zip | 23434
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Country | US
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Telephone | 757-634-7104
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Fax |
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Provider Business Mailing Address
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Address Line | 3604 PASTURE CV
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City | SUFFOLK
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State | VA
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Zip | 23435-3227
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Country | US
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Telephone | 757-634-7104
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904013463
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License Number State | VA
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