Provider Demographics
NPI:1275295255
Name:BEAVERS, ALEXANDRIA NICOLE
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:NICOLE
Last Name:BEAVERS
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 1:6338 LAURENTIAN CT
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-2039
Mailing Address - Country:US
Mailing Address - Phone:810-869-6345
Mailing Address - Fax:
Practice Address - Street 1:5877 LIVERNOIS RD STE 104
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-3100
Practice Address - Country:US
Practice Address - Phone:734-545-6335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty