Provider Demographics
NPI:1164950077
Name:MEDINA, ALEJANDRA ISABEL (MA, PLC, NCC)
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:ISABEL
Last Name:MEDINA
Suffix:
Gender:F
Credentials:MA, PLC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12111 HIDDEN VIEW CT
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48315-5922
Mailing Address - Country:US
Mailing Address - Phone:248-840-3376
Mailing Address - Fax:248-601-9991
Practice Address - Street 1:1460 WALTON BLVD STE 202
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1779
Practice Address - Country:US
Practice Address - Phone:248-840-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014391101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional