Provider Demographics
NPI:1699432864
Name:UTZ, ASHALEE RENE (LCSW, SOTP-TRAINEE)
Entity type:Individual
Prefix:
First Name:ASHALEE
Middle Name:RENE
Last Name:UTZ
Suffix:
Gender:F
Credentials:LCSW, SOTP-TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 PASTURE CV
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3227
Mailing Address - Country:US
Mailing Address - Phone:757-634-7104
Mailing Address - Fax:
Practice Address - Street 1:109.5 CLAY ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434
Practice Address - Country:US
Practice Address - Phone:757-634-7104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040134631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical