Provider Demographics
NPI:1174391601
Name:BATES, ASHLEY TAYLOR I (CSC-AD)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:TAYLOR
Last Name:BATES
Suffix:I
Gender:F
Credentials:CSC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 PAM ANN LN
Mailing Address - Street 2:
Mailing Address - City:LOTHIAN
Mailing Address - State:MD
Mailing Address - Zip Code:20711-2600
Mailing Address - Country:US
Mailing Address - Phone:443-214-5097
Mailing Address - Fax:
Practice Address - Street 1:1048 PAM ANN LN
Practice Address - Street 2:
Practice Address - City:LOTHIAN
Practice Address - State:MD
Practice Address - Zip Code:20711-2600
Practice Address - Country:US
Practice Address - Phone:443-214-5097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC3161101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)