Provider Demographics
NPI:1881206167
Name:PARKER, ALEXANDREA (LMSW)
Entity Type:Individual
Prefix:
First Name:ALEXANDREA
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 COVELL AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-5936
Mailing Address - Country:US
Mailing Address - Phone:517-927-6457
Mailing Address - Fax:
Practice Address - Street 1:6810 OLD 28TH ST SE STE 4
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6932
Practice Address - Country:US
Practice Address - Phone:616-264-5414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011122801041C0700X
MI6801105388101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health