Provider Demographics
NPI:1194460444
Name:SURA, ALEXANDREA LEIGH (LMSW)
Entity Type:Individual
Prefix:
First Name:ALEXANDREA
Middle Name:LEIGH
Last Name:SURA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VANTAGE WAY STE E130
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1591
Mailing Address - Country:US
Mailing Address - Phone:615-988-4763
Mailing Address - Fax:
Practice Address - Street 1:123 LUNA DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4116
Practice Address - Country:US
Practice Address - Phone:478-251-4283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000121751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical