Provider Demographics
NPI:1164572129
Name:TORRES, ALEXANDRIA MARIE (MA, LLP)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:MARIE
Last Name:TORRES
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:ALEXANDRIA
Other - Middle Name:MARIE
Other - Last Name:HORSFALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LLP
Mailing Address - Street 1:23875 MICHIGAN AVE # 490
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1805
Mailing Address - Country:US
Mailing Address - Phone:313-773-0012
Mailing Address - Fax:
Practice Address - Street 1:23875 MICHIGAN AVE # 490
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1805
Practice Address - Country:US
Practice Address - Phone:313-773-0012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361003257103TC1900X
MI6301012849103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6361003257OtherSTATE PROFESSIONAL LICENSE