Provider Demographics
NPI:1265859987
Name:BENEJAM, ALEXANDRA
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:BENEJAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 POWELL DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-1629
Mailing Address - Country:US
Mailing Address - Phone:309-368-3356
Mailing Address - Fax:
Practice Address - Street 1:15930 19 MILE RD
Practice Address - Street 2:BUILDING 200
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1155
Practice Address - Country:US
Practice Address - Phone:586-464-0175
Practice Address - Fax:586-464-0178
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5759103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical