Provider Demographics
NPI:1215342100
Name:GROOMS, ASHLEIGH ELIZABETH (MA, LMHC)
Entity type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:ELIZABETH
Last Name:GROOMS
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 US HIGHWAY 1
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5383
Mailing Address - Country:US
Mailing Address - Phone:321-631-5538
Mailing Address - Fax:
Practice Address - Street 1:4175 US HIGHWAY 1
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5383
Practice Address - Country:US
Practice Address - Phone:321-631-5538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12676101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health