Provider Demographics
NPI:1356192363
Name:HERNANDEZ, ALEJANDRO GAVINO (CLINICAL SPECIALIST)
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:GAVINO
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:CLINICAL SPECIALIST
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3029 STABLER ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-3051
Mailing Address - Country:US
Mailing Address - Phone:984-444-1017
Mailing Address - Fax:
Practice Address - Street 1:913 W HOLMES RD STE 200
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-0411
Practice Address - Country:US
Practice Address - Phone:517-887-0226
Practice Address - Fax:517-887-8121
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)