Provider Demographics
NPI:1598115586
Name:BOLLINGER, ALEXANDRA JORDAN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:JORDAN
Last Name:BOLLINGER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:JORDAN
Other - Last Name:HAYSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW-A
Mailing Address - Street 1:1452 LEWIS LANDING AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-4483
Mailing Address - Country:US
Mailing Address - Phone:239-595-0071
Mailing Address - Fax:
Practice Address - Street 1:1501 DOCK ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4936
Practice Address - Country:US
Practice Address - Phone:910-254-9898
Practice Address - Fax:910-254-9818
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0105651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical