Provider Demographics
NPI:1982208989
Name:GROOMS, ASHLEY
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:
Last Name:GROOMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 WHETSTONE WAY APT 325
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-5155
Mailing Address - Country:US
Mailing Address - Phone:480-388-2407
Mailing Address - Fax:
Practice Address - Street 1:1630 WHETSTONE WAY APT 325
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-5155
Practice Address - Country:US
Practice Address - Phone:480-388-2407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician