Provider Demographics
NPI:1366064669
Name:ROSLYN ASHFORD WELLNESS, INC.
Entity type:Organization
Organization Name:ROSLYN ASHFORD WELLNESS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSLYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ASHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:601-307-3917
Mailing Address - Street 1:54 MATTIE DR
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39437-5147
Mailing Address - Country:US
Mailing Address - Phone:601-307-3917
Mailing Address - Fax:
Practice Address - Street 1:409 W OAK ST STE 401D
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4169
Practice Address - Country:US
Practice Address - Phone:601-228-1144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-11
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty