Provider Demographics
NPI:1063701704
Name:ANDERSON, ASHLEY ELIZABETH (MA)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ELIZABETH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:ASHLEY
Other - Middle Name:ELIZABETH
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 EAST 162ND ST. SUITE 209
Mailing Address - Street 2:HERITAGE CENTER: REFUGE CHRISTIAN COUNSELING
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2237
Mailing Address - Country:US
Mailing Address - Phone:708-339-2769
Mailing Address - Fax:708-339-6776
Practice Address - Street 1:401 E 162ND ST STE 209
Practice Address - Street 2:HERITAGE CENTER: REFUGE CHRISTIAN COUNSELING
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2237
Practice Address - Country:US
Practice Address - Phone:708-339-2769
Practice Address - Fax:708-339-6776
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.006667101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor