Provider Demographics
NPI:1366222051
Name:DAFFRON, ASHLEY (LADAC, AADC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:DAFFRON
Suffix:
Gender:
Credentials:LADAC, AADC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:208 COBEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72437-9704
Mailing Address - Country:US
Mailing Address - Phone:870-293-5755
Mailing Address - Fax:870-709-0212
Practice Address - Street 1:208 COBEAN BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:AR
Practice Address - Zip Code:72437-9704
Practice Address - Country:US
Practice Address - Phone:870-293-5755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR516L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)