Provider Demographics
NPI:1790164804
Name:ALEXANDER, HEATHER N (LAC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:N
Last Name:ALEXANDER
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 1:1405 N TUCKAHOE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-8914
Mailing Address - Country:US
Mailing Address - Phone:856-906-6239
Mailing Address - Fax:
Practice Address - Street 1:987 DELSEA DR
Practice Address - Street 2:
Practice Address - City:FRANKLINVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08322-2313
Practice Address - Country:US
Practice Address - Phone:856-694-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00189500101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor