Provider Demographics
NPI:1194352534
Name:ASH-BRACKLEY, LAURA S (LCSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:S
Last Name:ASH-BRACKLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10369 AVENEL PL
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-5826
Mailing Address - Country:US
Mailing Address - Phone:804-363-5726
Mailing Address - Fax:
Practice Address - Street 1:10369 AVENEL PL
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-5826
Practice Address - Country:US
Practice Address - Phone:804-363-5726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040039901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical