MEDICARE: ASHLEY CANADY TOLAND DSW, LCSW, PIP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	3870C	AL
2	1041C0700X	Clinical Social Worker	3870-C	AL

General Provider Information

NPI Number	:	1376825216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY CANADY TOLAND DSW, LCSW, PIP

Provider Business Mailing Address
First Line	:	4150 LAKE CIR N
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36693-4411
Country	:	US
Telephone Number	:	479-926-3137
Fax Number	:

Provider Business Practice Location Address
First Line	:	613 GULF SHORES PKWY
Second Line	:	STE 204
City	:	GULF SHORES
State	:	AL
Zip	:	36542-6451
Country	:	US
Telephone Number	:	479-926-3137
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2011
Last Update Date	:	05/22/2024

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