Provider Demographics
NPI:1568731065
Name:ALEXANDER, ERICA DEVIN (LMSW)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:DEVIN
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LMSW
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 1
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:MO
Mailing Address - Zip Code:65256-0001
Mailing Address - Country:US
Mailing Address - Phone:573-874-0179
Mailing Address - Fax:573-875-0510
Practice Address - Street 1:9501 W COYOTE HILL RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:MO
Practice Address - Zip Code:65256-9598
Practice Address - Country:US
Practice Address - Phone:573-874-0179
Practice Address - Fax:573-875-0510
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110307321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical