Provider Demographics
NPI:1649868597
Name:WAHA, ALEXANDRA BOKOR (LMSW)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:BOKOR
Last Name:WAHA
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:MS
Other - First Name:ALEXANDRA
Other - Middle Name:BOKOR
Other - Last Name:HOLDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:12066 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-2068
Mailing Address - Country:US
Mailing Address - Phone:989-430-8619
Mailing Address - Fax:
Practice Address - Street 1:108 E GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1721
Practice Address - Country:US
Practice Address - Phone:231-547-8134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010948481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical