Provider Demographics
NPI:1114534195
Name:MONTGOMERY, ASHANTE BRIONNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ASHANTE
Middle Name:BRIONNE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3213 GLEN HILL DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-6297
Mailing Address - Country:US
Mailing Address - Phone:214-478-3838
Mailing Address - Fax:
Practice Address - Street 1:3213 GLEN HILL DR
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-6297
Practice Address - Country:US
Practice Address - Phone:214-478-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX580291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical