Provider Demographics
NPI:1932912573
Name:HARRIS, ASHLEY MONIQUE (CSAC-S)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MONIQUE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CSAC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 WESTWOOD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-4006
Mailing Address - Country:US
Mailing Address - Phone:786-269-3907
Mailing Address - Fax:
Practice Address - Street 1:2405 WESTWOOD AVE STE B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-4006
Practice Address - Country:US
Practice Address - Phone:786-269-3907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0709025220251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health