Provider Demographics
NPI:1417675067
Name:YU, ALEXANDER BRIAN (PHD, CMPC)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:BRIAN
Last Name:YU
Suffix:
Gender:M
Credentials:PHD, CMPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5205 LYNGATE CT STE A
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1693
Mailing Address - Country:US
Mailing Address - Phone:301-246-0194
Mailing Address - Fax:
Practice Address - Street 1:5205 LYNGATE CT STE A
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1693
Practice Address - Country:US
Practice Address - Phone:301-246-0194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06569103TC0700X, 103TE1100X
VA0810007914103TE1100X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports