Provider Demographics
NPI:1962637413
Name:COSTINEW, ALEX (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:COSTINEW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31700 W 13 MILE RD
Mailing Address - Street 2:STE 201
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2171
Mailing Address - Country:US
Mailing Address - Phone:248-478-0466
Mailing Address - Fax:248-478-0435
Practice Address - Street 1:38345 W 10 MILE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-2867
Practice Address - Country:US
Practice Address - Phone:248-478-0466
Practice Address - Fax:248-478-0435
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2016-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002052103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680F347340OtherBCBS
MI680F356960OtherBCBS