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Gina Ash

Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · East Saint Louis, IL

NPI 1275945123 · NPPES record last updated Aug 2, 2016

Key facts

NPI
1275945123
Entity type
Individual (NPI type 1)
Primary specialty
Addiction (Substance Use Disorder) Counselor 101YA0400X
License
A-4215-0001-A (IL)
Practice address
8704 State St
East Saint Louis, IL 62203-2048
Phone
(618) 207-3479
NPI assigned
May 27, 2014
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
27122ILMDAddiction (Substance Use Disorder) Counselor
A-4215-0001-AILMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Inspired Incorporated Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X A-4215-0001-A IL Yes
Case Manager/Care Coordinator 171M00000X
Addiction (Substance Use Disorder) Counselor 101YA0400X 27122 IL
Addiction (Substance Use Disorder) Counselor 101YA0400X 016271

Addresses

Primary practice location

8704 State St
East Saint Louis, IL 62203-2048

Mailing address

8704 State St
East Saint Louis, IL 62203-2048
Phone (618) 207-3479

Other providers in East Saint Louis, IL

All providers in East Saint Louis, IL · Addiction (Substance Use Disorder) Counselor in Illinois

Sources for this page

Verify at the official NPI Registry.