Provider Demographics
NPI:1679205983
Name:MOCK, ASHLEY MACAUL
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MACAUL
Last Name:MOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:MACAUL
Other - Last Name:BACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6460 HARRISON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7958
Mailing Address - Country:US
Mailing Address - Phone:513-467-2825
Mailing Address - Fax:513-694-0168
Practice Address - Street 1:1718 CENTRAL PKWY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45214-2355
Practice Address - Country:US
Practice Address - Phone:513-467-2825
Practice Address - Fax:513-694-0168
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.180930101YA0400X
OHCDCA.185111101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0493679Medicaid