Provider Demographics
NPI:1174899421
Name:YOUNGBLOOD, ASHLEY CARTER (LLMSW, LLMFT, CADC)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:CARTER
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:LLMSW, LLMFT, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-8120
Mailing Address - Country:US
Mailing Address - Phone:269-213-5002
Mailing Address - Fax:
Practice Address - Street 1:4155 S 9TH ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-8120
Practice Address - Country:US
Practice Address - Phone:269-213-5002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MI4101006666106H00000X
MI68010988131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist