Provider Demographics
NPI:1801417829
Name:ALEXANDER, SHAUNTAY DENISE (LMSW, LADAC II)
Entity Type:Individual
Prefix:
First Name:SHAUNTAY
Middle Name:DENISE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LMSW, LADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CYPRESS POINT RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38060-4661
Mailing Address - Country:US
Mailing Address - Phone:901-633-4762
Mailing Address - Fax:
Practice Address - Street 1:1331 UNION AVE STE 1000
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3513
Practice Address - Country:US
Practice Address - Phone:901-426-9357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10323104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker