Provider Demographics
NPI:1083747042
Name:ALEXANDER, PAMELA ELAINE (MS, NCAC II, CAC II)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ELAINE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MS, NCAC II, CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24339 COUNTRY SQUIRE ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-5724
Mailing Address - Country:US
Mailing Address - Phone:586-790-2732
Mailing Address - Fax:
Practice Address - Street 1:211 GLENDALE ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3231
Practice Address - Country:US
Practice Address - Phone:313-868-8223
Practice Address - Fax:313-868-8891
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI820844OtherSUBSTANCE ABUSE LICENSE