Provider Demographics
NPI:1780249086
Name:GOODRICH, ASHLEY (MS, LADC, MAC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:MS, LADC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 PICKETT PARK HWY
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38556-5881
Mailing Address - Country:US
Mailing Address - Phone:931-879-9454
Mailing Address - Fax:
Practice Address - Street 1:3636 PICKETT PARK HWY
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-5881
Practice Address - Country:US
Practice Address - Phone:931-879-9454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1314101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1730687104OtherTYPE 2 NPI