Provider Demographics
NPI:1730519570
Name:BEARDEN, ASHLEY
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BEARDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5809 GIBSON SHORES DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-3326
Mailing Address - Country:US
Mailing Address - Phone:863-838-9953
Mailing Address - Fax:863-284-0608
Practice Address - Street 1:308 E LEMON ST
Practice Address - Street 2:SUITE 105
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5048
Practice Address - Country:US
Practice Address - Phone:863-838-9953
Practice Address - Fax:863-284-0608
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP5425101YA0400X
FLMH12624101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)