Provider Demographics
NPI:1114772399
Name:MEYERS, MICHELINE ASHLEY (MSW)
Entity Type:Individual
Prefix:
First Name:MICHELINE
Middle Name:ASHLEY
Last Name:MEYERS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2592 SHORE DR APT 3
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1465
Mailing Address - Country:US
Mailing Address - Phone:757-581-5234
Mailing Address - Fax:
Practice Address - Street 1:2592 SHORE DR APT 3
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-1465
Practice Address - Country:US
Practice Address - Phone:757-581-5234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0906010054101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health