Provider Demographics
NPI:1326470543
Name:MERSHA, ASSEGID A (LLMSW)
Entity Type:Individual
Prefix:MR
First Name:ASSEGID
Middle Name:A
Last Name:MERSHA
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N MICHIGAN AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5306
Mailing Address - Country:US
Mailing Address - Phone:989-755-8225
Mailing Address - Fax:
Practice Address - Street 1:1600 N MICHIGAN AVE STE 404
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5306
Practice Address - Country:US
Practice Address - Phone:989-755-8225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010948901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical