Provider Demographics
NPI:1407128093
Name:KUBIAK, ALEXIS (NCC,AAC)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:
Last Name:KUBIAK
Suffix:
Gender:F
Credentials:NCC,AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98213-8810
Mailing Address - Country:US
Mailing Address - Phone:425-349-7386
Mailing Address - Fax:425-349-7339
Practice Address - Street 1:4526 FEDERAL AVE
Practice Address - Street 2:BUILDING 4
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2132
Practice Address - Country:US
Practice Address - Phone:425-349-7386
Practice Address - Fax:425-349-7339
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60268669101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health