Provider Demographics
NPI:1558868448
Name:ANDERSON, ALEXANDRIA LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 LA FRONTERA BLVD APT 3130
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-7959
Mailing Address - Country:US
Mailing Address - Phone:940-735-0905
Mailing Address - Fax:
Practice Address - Street 1:2800 LA FRONTERA BLVD APT 3130
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-7959
Practice Address - Country:US
Practice Address - Phone:940-735-0905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX569671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty