Provider Demographics
NPI:1679858690
Name:ASHTON, PAMELA SUE (MED, LADC)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:SUE
Last Name:ASHTON
Suffix:
Gender:F
Credentials:MED, LADC
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:SUE
Other - Last Name:ASHTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, LADC
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:131 MAIN ST., 2ND FL SUITE 3
Mailing Address - City:BRADFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05033-0056
Mailing Address - Country:US
Mailing Address - Phone:802-449-3123
Mailing Address - Fax:802-449-3123
Practice Address - Street 1:131 MAIN ST.
Practice Address - Street 2:2ND FL SUITE3
Practice Address - City:BRADFORD
Practice Address - State:VT
Practice Address - Zip Code:05033
Practice Address - Country:US
Practice Address - Phone:802-449-3123
Practice Address - Fax:802-449-3123
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000454101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)