Provider Demographics
NPI:1215344361
Name:COLON, ASHLEY W
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:W
Last Name:COLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GOLDMONT CT
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5509
Mailing Address - Country:US
Mailing Address - Phone:315-406-1865
Mailing Address - Fax:
Practice Address - Street 1:201 COLLEGE PL APT 316
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-0912
Practice Address - Country:US
Practice Address - Phone:757-615-3003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000409103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst