Healthcare Provider Details

I. General information

NPI: 1184551145
Provider Name (Legal Business Name): MELISSA ASHLEY TILL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 ATLANTIC AVE STE 2300
ATLANTIC CITY NJ
08401-7026
US

IV. Provider business mailing address

1401 ATLANTIC AVE STE 2300
ATLANTIC CITY NJ
08401-7026
US

V. Phone/Fax

Practice location:
  • Phone: 609-572-8697
  • Fax: 609-441-3905
Mailing address:
  • Phone: 609-572-8697
  • Fax: 609-441-3905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06652300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: