Provider Demographics
NPI:1770821449
Name:FUENTES-WHITMAN, ALEXANDRA MIRNA (LCSW)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MIRNA
Last Name:FUENTES-WHITMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALEJANDRA
Other - Middle Name:
Other - Last Name:FUENTES-WHITMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:250 EXECUTIVE PARK BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1534
Mailing Address - Country:US
Mailing Address - Phone:336-770-2477
Mailing Address - Fax:
Practice Address - Street 1:250 EXECUTIVE PARK BLVD STE 120
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1534
Practice Address - Country:US
Practice Address - Phone:336-770-2477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0157841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical