Provider Demographics
NPI:1043515174
Name:COMEGYS, ASHLEY CLARK (LCSW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CLARK
Last Name:COMEGYS
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:ELIZABETH
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3575 BRIDGE RD STE 8
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-1800
Mailing Address - Country:US
Mailing Address - Phone:504-534-5636
Mailing Address - Fax:504-230-0380
Practice Address - Street 1:11232 BOYETTE RD # 1021
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-8009
Practice Address - Country:US
Practice Address - Phone:504-534-5636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11180104100000X, 1041C0700X
COCSW.099264201041C0700X
FL187521041C0700X
VA09040179351041C0700X
HI40751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI796906Medicaid