Provider Demographics
NPI:1669719779
Name:LUPICO, ASHLEY E (MA, TLLP)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:E
Last Name:LUPICO
Suffix:
Gender:F
Credentials:MA, TLLP
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:E
Other - Last Name:WANCOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, TLLP
Mailing Address - Street 1:52456 FAYETTE DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-3054
Mailing Address - Country:US
Mailing Address - Phone:586-246-2055
Mailing Address - Fax:
Practice Address - Street 1:42140 VAN DYKE AVE STE 210
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-3676
Practice Address - Country:US
Practice Address - Phone:313-656-4052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015309103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist