Provider Demographics
NPI:1457177040
Name:CROCKHAM, ASHLEY DANYELLE (LCSW)
Entity type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:DANYELLE
Last Name:CROCKHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 CAMERON ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3713
Mailing Address - Country:US
Mailing Address - Phone:318-651-9363
Mailing Address - Fax:
Practice Address - Street 1:622 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3713
Practice Address - Country:US
Practice Address - Phone:318-398-0945
Practice Address - Fax:318-398-4314
Is Sole Proprietor?:No
Enumeration Date:2024-11-27
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA172711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical