Provider Demographics
NPI:1629499413
Name:ALEXANDRE, BLONDINE (LCSW-C)
Entity Type:Individual
Prefix:MISS
First Name:BLONDINE
Middle Name:
Last Name:ALEXANDRE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 GREEN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4046
Mailing Address - Country:US
Mailing Address - Phone:301-728-0371
Mailing Address - Fax:
Practice Address - Street 1:14300 GALLANT FOX LN STE 107
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4031
Practice Address - Country:US
Practice Address - Phone:202-830-4320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-20
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD163131041C0700X, 104100000X
DCLC500811991041C0700X
VA09040111151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD$$$$$$$$$Medicaid