Provider Demographics
NPI:1184194979
Name:ROSS, ALEXANDRA ROSE (LLPC)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:ROSE
Last Name:ROSS
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:MS
Other - First Name:ALEXANDRA
Other - Middle Name:ROSE
Other - Last Name:NEWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:418 2ND ST APT 5
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-4962
Mailing Address - Country:US
Mailing Address - Phone:248-978-2363
Mailing Address - Fax:
Practice Address - Street 1:2350 WASHTENAW AVE STE 7
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4525
Practice Address - Country:US
Practice Address - Phone:248-978-2363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016140101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401016140OtherPROFESSIONAL COUNSELOR EDUCATIONAL LIMITED LICENSE