Provider Demographics
NPI:1366025504
Name:ASHTON, MELISSA (ISW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ASHTON
Suffix:
Gender:F
Credentials:ISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2577 ULYSSES RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-4850
Mailing Address - Country:US
Mailing Address - Phone:954-547-5369
Mailing Address - Fax:
Practice Address - Street 1:317 E CALL ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-7609
Practice Address - Country:US
Practice Address - Phone:850-222-2747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW12538101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL866853510OtherNASW MEMBERSHIP NUMBER
FLISW12538OtherINTERN SW IDENTIFICATION NUMBER