Provider Demographics
NPI:1609032630
Name:ALEXANDER, PATSY GARDNER (MSW LISW-CP)
Entity Type:Individual
Prefix:MS
First Name:PATSY
Middle Name:GARDNER
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MSW LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1203 48TH AVE N
Mailing Address - Street 2:UNIT 202
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5425
Mailing Address - Country:US
Mailing Address - Phone:843-449-3086
Mailing Address - Fax:843-449-6851
Practice Address - Street 1:1203 48TH AVE N
Practice Address - Street 2:UNIT 202
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5425
Practice Address - Country:US
Practice Address - Phone:843-449-3086
Practice Address - Fax:843-449-6851
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5455101Y00000X, 104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1085Medicaid
SCQ315759348Medicare UPIN
SCSW1085Medicaid
SCQ315751879Medicare UPIN