Provider Demographics
NPI:1700444148
Name:STEVENSON, ALEXANDRA DANLAG
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:DANLAG
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2693 COPILICO TER
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4821
Mailing Address - Country:US
Mailing Address - Phone:702-881-3502
Mailing Address - Fax:
Practice Address - Street 1:3320 N BUFFALO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7443
Practice Address - Country:US
Practice Address - Phone:702-659-4825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10791-M1041C0700X
225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical