Provider Demographics
NPI:1942545942
Name:ALEXANDRIA PLACE THERAPY, LLC
Entity Type:Organization
Organization Name:ALEXANDRIA PLACE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:JALAZO
Authorized Official - Last Name:HALPERN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, RPT
Authorized Official - Phone:202-253-7503
Mailing Address - Street 1:108A S COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-3051
Mailing Address - Country:US
Mailing Address - Phone:703-963-4261
Mailing Address - Fax:
Practice Address - Street 1:108A S COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3051
Practice Address - Country:US
Practice Address - Phone:703-963-4261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-02
Last Update Date:2012-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004171103TC0700X
VA09040063271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty