Provider Demographics
NPI:1154928380
Name:CERESA, ASHLEY NICOLE (JD, LMSW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICOLE
Last Name:CERESA
Suffix:
Gender:F
Credentials:JD, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 N DEL REY DR
Mailing Address - Street 2:
Mailing Address - City:OTIS ORCHARDS
Mailing Address - State:WA
Mailing Address - Zip Code:99027-5105
Mailing Address - Country:US
Mailing Address - Phone:831-227-3768
Mailing Address - Fax:
Practice Address - Street 1:5108 N DEL REY DR
Practice Address - Street 2:
Practice Address - City:OTIS ORCHARDS
Practice Address - State:WA
Practice Address - Zip Code:99027-5105
Practice Address - Country:US
Practice Address - Phone:831-227-3768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health