Provider Demographics
NPI:1407530280
Name:HOEKSTRA, ALEXANDRIA R (LLC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:R
Last Name:HOEKSTRA
Suffix:
Gender:F
Credentials:LLC
Other - Prefix:
Other - First Name:ALEXANDRIA
Other - Middle Name:R
Other - Last Name:FENNEMEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLC
Mailing Address - Street 1:217 E 24TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4973
Mailing Address - Country:US
Mailing Address - Phone:616-209-9204
Mailing Address - Fax:
Practice Address - Street 1:217 E 24TH ST STE 201
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4973
Practice Address - Country:US
Practice Address - Phone:616-209-9204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023060101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health