Provider Demographics
NPI:1992002919
Name:LOVELL, ALEXIS (CADC II)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:LOVELL
Suffix:
Gender:F
Credentials:CADC II
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:RICHELLE
Other - Last Name:EWANISZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3645 RUFFIN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1845
Mailing Address - Country:US
Mailing Address - Phone:858-384-6284
Mailing Address - Fax:858-384-6453
Practice Address - Street 1:3645 RUFFIN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1845
Practice Address - Country:US
Practice Address - Phone:858-384-6284
Practice Address - Fax:858-384-6453
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)