Provider Demographics
NPI:1992446074
Name:BAGLEY, ASHLEY INGRID (LPC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:INGRID
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-2443
Mailing Address - Country:US
Mailing Address - Phone:704-807-0694
Mailing Address - Fax:
Practice Address - Street 1:724 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-2443
Practice Address - Country:US
Practice Address - Phone:704-807-0694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008824101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional