Provider Demographics
NPI:1194368175
Name:MICHAEL, ASHANTI S
Entity type:Individual
Prefix:MS
First Name:ASHANTI
Middle Name:S
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5106A ABERDEEN DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-5625
Mailing Address - Country:US
Mailing Address - Phone:732-609-4601
Mailing Address - Fax:
Practice Address - Street 1:7 DUNMORE AVE
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-1937
Practice Address - Country:US
Practice Address - Phone:609-915-3387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC063966001041C0700X
251B00000X
NJ44SL06716600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251B00000XAgenciesCase Management