Provider Demographics
NPI:1902246606
Name:ROTHBERG, ASHLEY RENEE (LCSW, LCDC, MPH)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:RENEE
Last Name:ROTHBERG
Suffix:
Gender:F
Credentials:LCSW, LCDC, MPH
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:RENEE
Other - Last Name:DAVIS-DENIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 N SAM HOUSTON PKWY W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067-4338
Mailing Address - Country:US
Mailing Address - Phone:832-828-1005
Mailing Address - Fax:832-825-0264
Practice Address - Street 1:2218 KINBROOK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-6115
Practice Address - Country:US
Practice Address - Phone:832-452-2503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11714101YA0400X
1041C0700X
TX55355104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical