Basic Information
| Provider Information | |||||||||
| NPI: | 1841806510 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COPEN | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | SIERRA | ||||||||
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| Credential: | MSW, LGSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4602 MACCORKLE AVE SE | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253041848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042057335 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4602 MACCORKLE AVE SE | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253041848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042057535 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2020 | ||||||||
| LastUpdateDate: | 09/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | BP00945240 | WV | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.