Provider Demographics
NPI:1316373798
Name:MCDONALD, ALEXIS DEANNA (LCMSW)
Entity Type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:DEANNA
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LCMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25900 GREENFIELD RD STE 503
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1893
Mailing Address - Country:US
Mailing Address - Phone:313-402-4570
Mailing Address - Fax:313-781-0389
Practice Address - Street 1:25900 GREENFIELD RD STE 503
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1893
Practice Address - Country:US
Practice Address - Phone:313-402-4570
Practice Address - Fax:313-781-0389
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010913011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical