Provider Demographics
NPI:1275155871
Name:MERRYMAN, ASHLEIGH R (LLMSW)
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:R
Last Name:MERRYMAN
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9929 BOULDER CT
Mailing Address - Street 2:
Mailing Address - City:DAVISBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48350-2053
Mailing Address - Country:US
Mailing Address - Phone:586-265-6986
Mailing Address - Fax:
Practice Address - Street 1:4318 MILLER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1267
Practice Address - Country:US
Practice Address - Phone:810-249-9924
Practice Address - Fax:810-249-9927
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011069671041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty