Healthcare Provider Details

I. General information

NPI: 1184129496
Provider Name (Legal Business Name): ASHLEE ZYKORIE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 PERRY AVE
MOORESTOWN NJ
08057-1846
US

IV. Provider business mailing address

188 PERRY AVE
MOORESTOWN NJ
08057-1846
US

V. Phone/Fax

Practice location:
  • Phone: 609-351-7874
  • Fax:
Mailing address:
  • Phone: 609-351-7874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00621000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: