Provider Demographics
NPI:1003271198
Name:ALEXANDER, NICOLE RUFINA (LCSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:RUFINA
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 OLD SALEM RD SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2229
Mailing Address - Country:US
Mailing Address - Phone:678-491-7606
Mailing Address - Fax:678-607-8989
Practice Address - Street 1:506 S BROAD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2172
Practice Address - Country:US
Practice Address - Phone:800-560-1267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical