Provider Demographics
NPI:1528510161
Name:WALTRIP, ASHLEY CORNELL (PSYD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CORNELL
Last Name:WALTRIP
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:MARIE
Other - Last Name:CORNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 LELA LN
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-3718
Mailing Address - Country:US
Mailing Address - Phone:757-618-6565
Mailing Address - Fax:
Practice Address - Street 1:901 LELA LN
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-3718
Practice Address - Country:US
Practice Address - Phone:757-618-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005561103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical