Provider Demographics
NPI:1760204937
Name:QUELCH, ASHLEY VICTORIA (BA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:VICTORIA
Last Name:QUELCH
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PIERCE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05150-9752
Mailing Address - Country:US
Mailing Address - Phone:802-591-1197
Mailing Address - Fax:
Practice Address - Street 1:12 PIERCE RD
Practice Address - Street 2:
Practice Address - City:NORTH SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05150-9752
Practice Address - Country:US
Practice Address - Phone:802-591-1197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health