Provider Demographics
NPI:1629793260
Name:POE, ALEXANDRIA ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:ELIZABETH
Last Name:POE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 KAS VILLA ACRES
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IL
Mailing Address - Zip Code:61951-9107
Mailing Address - Country:US
Mailing Address - Phone:217-521-9276
Mailing Address - Fax:
Practice Address - Street 1:16 KAS VILLA ACRES
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IL
Practice Address - Zip Code:61951-9107
Practice Address - Country:US
Practice Address - Phone:217-521-9276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0249061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical