Provider Demographics
NPI:1699826248
Name:PERSHING, AMY THERESA (MSW, LMSW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:THERESA
Last Name:PERSHING
Suffix:
Gender:F
Credentials:MSW, LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N 1ST ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-1397
Mailing Address - Country:US
Mailing Address - Phone:734-668-8585
Mailing Address - Fax:
Practice Address - Street 1:111 N 1ST ST
Practice Address - Street 2:SUITE #2
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1397
Practice Address - Country:US
Practice Address - Phone:734-668-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010659051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical