Provider Demographics
NPI:1841569340
Name:ALEXANDER, LISA MARIE
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:ALEXANDER
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 1:3600 POWER INN RD STE E
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3826
Mailing Address - Country:US
Mailing Address - Phone:916-868-1021
Mailing Address - Fax:
Practice Address - Street 1:3600 POWER INN RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3826
Practice Address - Country:US
Practice Address - Phone:916-868-1021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10OtherBEHAVIORAL HEALTH