Provider Demographics
NPI:1669184495
Name:FAGAN-WILLIAMS, ALEXIS LEIGH
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:LEIGH
Last Name:FAGAN-WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:LEIGH
Other - Last Name:FAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7375 WOODWARD AVE STE 2800
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3157
Mailing Address - Country:US
Mailing Address - Phone:313-710-8744
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:7375 WOODWARD AVE STE 2800
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3157
Practice Address - Country:US
Practice Address - Phone:313-710-8744
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2022-12-26
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician