Provider Demographics
NPI:1720558208
Name:ALEXANDER, EVELYN SIMONE (MSW,CIT)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:SIMONE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MSW,CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4271 S LEE ST
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3710
Mailing Address - Country:US
Mailing Address - Phone:678-765-8160
Mailing Address - Fax:
Practice Address - Street 1:4271 S LEE ST
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3710
Practice Address - Country:US
Practice Address - Phone:678-765-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)