Provider Demographics
NPI:1700284049
Name:ALEXANDER, SHIRLEY (MS, CAC-AD, CAD-AS)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MS, CAC-AD, CAD-AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 GLEMSFORD RD
Mailing Address - Street 2:APT L
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-5547
Mailing Address - Country:US
Mailing Address - Phone:862-262-5492
Mailing Address - Fax:
Practice Address - Street 1:203 W PULASKI HWY
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5910
Practice Address - Country:US
Practice Address - Phone:443-485-6544
Practice Address - Fax:443-485-6442
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD671101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional