Provider Demographics
NPI:1710609649
Name:MICHEL, ALEXIS JORDAN (LAC)
Entity Type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:JORDAN
Last Name:MICHEL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 ARBOR PL
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-1424
Mailing Address - Country:US
Mailing Address - Phone:201-310-0324
Mailing Address - Fax:
Practice Address - Street 1:479 ARBOR PL
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-1424
Practice Address - Country:US
Practice Address - Phone:201-310-0324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00656900101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor