Provider Demographics
NPI:1669109245
Name:MICKLE, ASHLEY C (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:C
Last Name:MICKLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:CARLITA
Other - Last Name:COLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 780125
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0125
Mailing Address - Country:US
Mailing Address - Phone:804-922-4844
Mailing Address - Fax:
Practice Address - Street 1:2116 W LABURNUM AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-4359
Practice Address - Country:US
Practice Address - Phone:804-254-3500
Practice Address - Fax:804-254-1616
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040142341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical