Provider Demographics
NPI:1619136090
Name:LASHLEY, MICHELLE ARLENE (CRC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ARLENE
Last Name:LASHLEY
Suffix:
Gender:F
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1084 BLAKE AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-3636
Mailing Address - Country:US
Mailing Address - Phone:718-485-1149
Mailing Address - Fax:718-485-1149
Practice Address - Street 1:2250 RYER AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-1104
Practice Address - Country:US
Practice Address - Phone:718-960-0680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL00101853101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor