Provider Demographics
NPI:1558983767
Name:ALEXANDER-BIRD, MARISSA DANIELLE (CP61230883)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:DANIELLE
Last Name:ALEXANDER-BIRD
Suffix:
Gender:F
Credentials:CP61230883
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 4627
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-0627
Mailing Address - Country:US
Mailing Address - Phone:509-624-1244
Mailing Address - Fax:
Practice Address - Street 1:2317 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-5809
Practice Address - Country:US
Practice Address - Phone:509-624-1244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP61230883101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2256226Medicaid