Provider Demographics
NPI:1649921073
Name:PERSONS, ALEXANDER D (LCSW-C)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:D
Last Name:PERSONS
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 HASTINGS RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21286-7825
Mailing Address - Country:US
Mailing Address - Phone:443-934-2543
Mailing Address - Fax:
Practice Address - Street 1:628 HASTINGS RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286-7825
Practice Address - Country:US
Practice Address - Phone:443-934-2543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23906101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health