Provider Demographics
NPI:1417554148
Name:ALEXANDER, DESTINY LYNN
Entity Type:Individual
Prefix:MISS
First Name:DESTINY
Middle Name:LYNN
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 S MAIN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1203
Mailing Address - Country:US
Mailing Address - Phone:234-334-3113
Mailing Address - Fax:
Practice Address - Street 1:331 S MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1203
Practice Address - Country:US
Practice Address - Phone:234-334-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator