Provider Demographics
NPI:1942675947
Name:ALEXANDER-FICKLIN, DEADRIAN
Entity Type:Individual
Prefix:MRS
First Name:DEADRIAN
Middle Name:
Last Name:ALEXANDER-FICKLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 BIENVILLE SQ
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5069
Mailing Address - Country:US
Mailing Address - Phone:318-238-4030
Mailing Address - Fax:318-787-5768
Practice Address - Street 1:113 BIENVILLE SQ
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5069
Practice Address - Country:US
Practice Address - Phone:318-238-4030
Practice Address - Fax:318-787-5768
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251S00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health