Provider Demographics
NPI:1104617406
Name:KINCHEN, ASHLEY RAE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RAE
Last Name:KINCHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 LAKE OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-3835
Mailing Address - Country:US
Mailing Address - Phone:407-341-0050
Mailing Address - Fax:
Practice Address - Street 1:1964 HOWELL BRANCH RD STE 106
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1042
Practice Address - Country:US
Practice Address - Phone:407-676-4299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH27096101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health