Healthcare Provider Details

I. General information

NPI: 1447171418
Provider Name (Legal Business Name): I AM UNIQUE A SELF RESTORATION WORKSHOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 ROUTE 38 STE 103
MOUNT LAUREL NJ
08054-9750
US

IV. Provider business mailing address

3201 ROUTE 38 STE 103
MOUNT LAUREL NJ
08054-9750
US

V. Phone/Fax

Practice location:
  • Phone: 609-533-5643
  • Fax:
Mailing address:
  • Phone: 908-386-1162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ASHANA EVETTE WILLIAMS-BUSH
Title or Position: FOUNDER/EXECUTIVE DIRECTOR
Credential: DOCTORATE DEGREE
Phone: 609-526-4075