Provider Demographics
NPI:1386495273
Name:DOUGLAS, ASHLEY LASHAY
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LASHAY
Last Name:DOUGLAS
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 1:4 SOMER DR
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-1730
Mailing Address - Country:US
Mailing Address - Phone:608-598-0670
Mailing Address - Fax:
Practice Address - Street 1:4 SOMER DR
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-1730
Practice Address - Country:US
Practice Address - Phone:608-598-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation