Provider Demographics
NPI:1629379672
Name:COUGHLIN, ALEXANDRA CRAMER (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:CRAMER
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 GUTHRIE AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-1818
Mailing Address - Country:US
Mailing Address - Phone:703-745-2234
Mailing Address - Fax:
Practice Address - Street 1:231 GUTHRIE AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22305-1818
Practice Address - Country:US
Practice Address - Phone:703-745-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500777541041C0700X
MD121181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical