Provider Demographics
NPI:1760999445
Name:ALEXANDER, CASSANDRA THEA (CADC-CAS)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:THEA
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:CADC-CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:CA
Mailing Address - Zip Code:93510-0025
Mailing Address - Country:US
Mailing Address - Phone:661-223-8754
Mailing Address - Fax:661-269-2853
Practice Address - Street 1:30500 ARRASTRE CANYON RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:CA
Practice Address - Zip Code:93510-2160
Practice Address - Country:US
Practice Address - Phone:661-223-8754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC26421214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)