Provider Demographics
NPI:1972282176
Name:WASHBURN, ALEXANDRA KRISTINE (LCMHCA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:KRISTINE
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 FOUNTAIN VW
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5829
Mailing Address - Country:US
Mailing Address - Phone:770-542-7682
Mailing Address - Fax:
Practice Address - Street 1:6633 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3321
Practice Address - Country:US
Practice Address - Phone:800-736-3739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional