Basic Information
| Provider Information | |||||||||
| NPI: | 1033732631 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | FREEMAN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LGSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 65 PROFESSIONAL PL STE 102 | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 263300259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048485770 | ||||||||
| FaxNumber: | 3048480890 | ||||||||
| Practice Location | |||||||||
| Address1: | 65 PROFESSIONAL PL STE 102 | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 263300259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048485770 | ||||||||
| FaxNumber: | 3048480890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2020 | ||||||||
| LastUpdateDate: | 05/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | SW042015486 | WV | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.