Provider Demographics
NPI:1851851760
Name:KARNICK, ALEXANDREA CHRISTINE I (MS, LCACA)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDREA
Middle Name:CHRISTINE
Last Name:KARNICK
Suffix:I
Gender:F
Credentials:MS, LCACA
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 1430
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-9230
Mailing Address - Country:US
Mailing Address - Phone:219-763-8112
Mailing Address - Fax:219-764-5380
Practice Address - Street 1:801 BROADWAY
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-2230
Practice Address - Country:US
Practice Address - Phone:219-763-8112
Practice Address - Fax:219-763-8937
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87900013A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)