Provider Demographics
NPI:1710671102
Name:PAYNTER, ALEXANDRIA PAGE (LLBSW)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:PAGE
Last Name:PAYNTER
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MULHOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-7693
Mailing Address - Country:US
Mailing Address - Phone:989-895-2324
Mailing Address - Fax:
Practice Address - Street 1:201 MULHOLLAND ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-7693
Practice Address - Country:US
Practice Address - Phone:989-895-2324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6852093700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty