Provider Demographics
NPI:1194210252
Name:ALEXANDER, JOE DARRY
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:DARRY
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 E ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-2024
Mailing Address - Country:US
Mailing Address - Phone:619-233-3346
Mailing Address - Fax:619-234-3357
Practice Address - Street 1:2410 E ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-2024
Practice Address - Country:US
Practice Address - Phone:619-234-3346
Practice Address - Fax:619-234-3357
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII057890518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty