Provider Demographics
NPI:1750150371
Name:ALEXANDER, ASHITA (LAC)
Entity type:Individual
Prefix:
First Name:ASHITA
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 FISH HATCHERY RD
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-9227
Mailing Address - Country:US
Mailing Address - Phone:970-577-4707
Mailing Address - Fax:
Practice Address - Street 1:1600 FISH HATCHERY RD
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-9227
Practice Address - Country:US
Practice Address - Phone:970-577-4707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0002070101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty