Provider Demographics
NPI:1649051624
Name:YOUSIF, ALEXANDER PETER (CPSS)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:PETER
Last Name:YOUSIF
Suffix:
Gender:M
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 DUNSTAN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2390
Mailing Address - Country:US
Mailing Address - Phone:984-282-6654
Mailing Address - Fax:
Practice Address - Street 1:415 DUNSTAN AVE STE B
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2390
Practice Address - Country:US
Practice Address - Phone:984-377-8576
Practice Address - Fax:984-208-5220
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2024-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-11487-01175T00000X, 175T00000X
NC1649051624405300000X, 405300000X
251B00000X, 251S00000X, 171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
No405300000XOther Service ProvidersPrevention Professional
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2024-11487-01OtherBEHAVIORAL HEALTH SPRINGBOARD - UNC SCHOOL OF SOCIAL WORK