Provider Demographics
NPI:1699300285
Name:HENDRICKS, ASHLEY DANIELLE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DANIELLE
Last Name:HENDRICKS
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 1:2662 APRIL DAWN WAY
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1412
Mailing Address - Country:US
Mailing Address - Phone:240-817-8816
Mailing Address - Fax:
Practice Address - Street 1:2134 ESPEY CT STE 3
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2437
Practice Address - Country:US
Practice Address - Phone:443-292-6760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC200001593101YM0800X
106S00000X
MDLGP14674101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician