Provider Demographics
NPI:1558795609
Name:MILLER, ASHLEY MARIE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:MARIE
Other - Last Name:JACKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW
Mailing Address - Street 1:10339 SOUTHERN MARYLAND BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-3018
Mailing Address - Country:US
Mailing Address - Phone:301-327-5417
Mailing Address - Fax:
Practice Address - Street 1:10339 SOUTHERN MARYLAND BLVD STE 209
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-3018
Practice Address - Country:US
Practice Address - Phone:301-327-5417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19997104100000X, 1041C0700X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD346646OtherMHN/TRICARE
MD609550004Medicaid
MDR968OtherCAREFIRST BCBS
MD609550001Medicaid
MD7840093OtherAETNA
MD517251OtherOPTUM/UBH
MD742LMedicare PIN