Provider Demographics
NPI:1669150926
Name:ALEXIS, YANNICK MICHAEL
Entity type:Individual
Prefix:
First Name:YANNICK
Middle Name:MICHAEL
Last Name:ALEXIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 CORDOBA ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1717
Mailing Address - Country:US
Mailing Address - Phone:301-256-4826
Mailing Address - Fax:
Practice Address - Street 1:15350 N COMMERCE DR STE 204
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1234
Practice Address - Country:US
Practice Address - Phone:248-871-7042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511170591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical