Healthcare Provider Details

I. General information

NPI: 1194368175
Provider Name (Legal Business Name): MS. ASHANTI S MICHAEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 DUNMORE AVE
EWING NJ
08618-1937
US

IV. Provider business mailing address

5106A ABERDEEN DR
MOUNT LAUREL NJ
08054-5625
US

V. Phone/Fax

Practice location:
  • Phone: 609-915-3387
  • Fax:
Mailing address:
  • Phone: 732-609-4601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06396600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06716600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: