Provider Demographics
NPI:1548619299
Name:POLK, ASHIYAH M
Entity type:Individual
Prefix:
First Name:ASHIYAH
Middle Name:M
Last Name:POLK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 MERRYDALE DR
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-5422
Mailing Address - Country:US
Mailing Address - Phone:228-731-5156
Mailing Address - Fax:
Practice Address - Street 1:1003 MERRYDALE DR
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-5422
Practice Address - Country:US
Practice Address - Phone:228-731-5156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health