Provider Demographics
NPI:1376075432
Name:ALEXANDER, TISHONE YVONNE (MS)
Entity Type:Individual
Prefix:
First Name:TISHONE
Middle Name:YVONNE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 FARRINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151
Mailing Address - Country:US
Mailing Address - Phone:215-796-5053
Mailing Address - Fax:
Practice Address - Street 1:1802 FARRINGTON RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2011
Practice Address - Country:US
Practice Address - Phone:215-796-5053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health