Provider Demographics
NPI:1871122366
Name:I AM ASHLEY MONAE COLLECTION LLC
Entity type:Organization
Organization Name:I AM ASHLEY MONAE COLLECTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:HAIR LOSS SPECIALIST
Authorized Official - Phone:313-651-6995
Mailing Address - Street 1:4742 TRUMBULL ST APT 1D
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-2994
Mailing Address - Country:US
Mailing Address - Phone:313-651-6995
Mailing Address - Fax:
Practice Address - Street 1:29746 SOUTHFIELD RD STE 204
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2088
Practice Address - Country:US
Practice Address - Phone:313-651-6995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty