Provider Demographics
NPI:1134980733
Name:MELCHOR, ASHLEY ELIZABETH (LLMSW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ELIZABETH
Last Name:MELCHOR
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4856 ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-1844
Mailing Address - Country:US
Mailing Address - Phone:313-310-5595
Mailing Address - Fax:
Practice Address - Street 1:4856 ROOSEVELT ST.
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208
Practice Address - Country:US
Practice Address - Phone:313-310-5595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511176741041C0700X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical