Provider Demographics
NPI:1083999551
Name:PANK, ASHLEIGH (LLPC)
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:
Last Name:PANK
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:ASHLEIGH
Other - Middle Name:
Other - Last Name:EWALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, MS, RAC
Mailing Address - Street 1:585 JEWETT RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-8729
Mailing Address - Country:US
Mailing Address - Phone:517-676-5405
Mailing Address - Fax:517-676-5460
Practice Address - Street 1:585 JEWETT RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-8729
Practice Address - Country:US
Practice Address - Phone:517-676-5405
Practice Address - Fax:517-676-5460
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MI6401014152171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)