Provider Demographics
NPI:1861175390
Name:GARDNER-CORMIER, ASHLEIGH B (LMSW)
Entity type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:B
Last Name:GARDNER-CORMIER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20514 HEATH HOUSE
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-1299
Mailing Address - Country:US
Mailing Address - Phone:832-334-1370
Mailing Address - Fax:
Practice Address - Street 1:1040 SAKELARES BLVD
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-3819
Practice Address - Country:US
Practice Address - Phone:505-876-1890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2023-0811104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker