Basic Information
| Provider Information | |||||||||
| NPI: | 1275155871 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERRYMAN | ||||||||
| FirstName: | ASHLEIGH | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | LLMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9929 BOULDER CT | ||||||||
| Address2: | |||||||||
| City: | DAVISBURG | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483502053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862656986 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4318 MILLER RD | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485071267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102499924 | ||||||||
| FaxNumber: | 8102499927 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2020 | ||||||||
| LastUpdateDate: | 11/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801106967 | MI | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | 6801106967 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.