Provider Demographics
NPI:1902003692
Name:BARBOUR, ALEXIA DENINE (BHS SST)
Entity Type:Individual
Prefix:
First Name:ALEXIA
Middle Name:DENINE
Last Name:BARBOUR
Suffix:
Gender:F
Credentials:BHS SST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14410 E 9 MILE RD APT 102
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-2725
Mailing Address - Country:US
Mailing Address - Phone:313-879-7475
Mailing Address - Fax:
Practice Address - Street 1:35555 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-5517
Practice Address - Country:US
Practice Address - Phone:586-792-1654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker