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General NPI Number Information
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NPI Number | 1861175390
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Entity Type | Individual
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Provider Name | ASHLEIGH B GARDNER-CORMIER LMSW
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Gender | Female
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Dates
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Enumeration Date | 08/10/2023
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Last Update Date | 08/10/2023
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Provider Practice Location Address
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Address Line | 1040 SAKELARES BLVD
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City | GRANTS
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State | NM
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Zip | 87020-3819
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Country | US
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Telephone | 505-876-1890
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Fax |
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Provider Business Mailing Address
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Address Line | 20514 HEATH HOUSE
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City | PORTER
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State | TX
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Zip | 77365-1299
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Country | US
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Telephone | 832-334-1370
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SWB-2023-0811
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License Number State | NM
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