Provider Demographics
NPI:1275743650
Name:ALEXANDER, SHANIA S (BS, FAODP)
Entity Type:Individual
Prefix:MS
First Name:SHANIA
Middle Name:S
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:BS, FAODP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 PALMER DR
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-1861
Mailing Address - Country:US
Mailing Address - Phone:248-340-0650
Mailing Address - Fax:
Practice Address - Street 1:1255 N. OAKLAND BLVD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327
Practice Address - Country:US
Practice Address - Phone:248-406-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)