Healthcare Provider Details

I. General information

NPI: 1225651961
Provider Name (Legal Business Name): ASHLEY CLARK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2368 S MILFORD RD
HIGHLAND MI
48357-4934
US

IV. Provider business mailing address

2368 S MILFORD RD
HIGHLAND MI
48357-4934
US

V. Phone/Fax

Practice location:
  • Phone: 248-645-8130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801121770
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: