Provider Demographics
NPI:1750453387
Name:ALEXANDER, WILLIE JAMES (LMFT)
Entity Type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:JAMES
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:MR
Other - First Name:WILLIE
Other - Middle Name:JAMES
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:208-B S RUTHERFORD ST
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-2652
Mailing Address - Country:US
Mailing Address - Phone:704-694-0186
Mailing Address - Fax:704-695-1759
Practice Address - Street 1:208-B S RUTHERFORD ST
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2652
Practice Address - Country:US
Practice Address - Phone:704-694-0186
Practice Address - Fax:704-694-0185
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC941101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105032Medicaid