Provider Demographics
NPI:1073358461
Name:RICHMOND, ASHLEY M (N/A)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:M
Other - Last Name:RICHMOND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ASH
Mailing Address - Street 1:2278 APPLEGATE DR NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-7226
Mailing Address - Country:US
Mailing Address - Phone:616-970-7107
Mailing Address - Fax:
Practice Address - Street 1:2278 APPLEGATE DR NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-7226
Practice Address - Country:US
Practice Address - Phone:616-970-7107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician