Provider Demographics
NPI:1598948408
Name:ALEXANDER, GREGORY CHARLES
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:CHARLES
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 1ST AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4803
Mailing Address - Country:US
Mailing Address - Phone:907-459-3800
Mailing Address - Fax:907-459-3835
Practice Address - Street 1:122 1ST AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4803
Practice Address - Country:US
Practice Address - Phone:907-459-3800
Practice Address - Fax:907-459-3835
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDA4380Medicaid