Provider Demographics
NPI:1023893021
Name:DIAZ-SHOVAN, ALEXANDRIA MICHELLE (LMSW)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:MICHELLE
Last Name:DIAZ-SHOVAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 BYTE CT STE G
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-8724
Mailing Address - Country:US
Mailing Address - Phone:301-846-7872
Mailing Address - Fax:301-846-7973
Practice Address - Street 1:21 BYTE CT STE G
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-8724
Practice Address - Country:US
Practice Address - Phone:301-846-7872
Practice Address - Fax:301-846-7973
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30559104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker