Individual
ASHLIE LYNN BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
1698 LIBERTY ST SE, SALEM, OR 97302-4348
(503) 884-5764
Mailing address
1144 WALLACE RD NW # A702, SALEM, OR 97304-3116
(503) 602-1941
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
R5804
OR
101YM0800X
Mental Health Counselor
Primary
R5804
OR
175T00000X
Peer Specialist
—
—
Other
Enumeration date
03/24/2017
Last updated
06/21/2022
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