Provider Demographics
NPI:1881274629
Name:ADALBERT, ALEXANDRA JADE (LGPC)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:JADE
Last Name:ADALBERT
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 FLAGSHIP RD
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-4423
Mailing Address - Country:US
Mailing Address - Phone:206-331-6145
Mailing Address - Fax:
Practice Address - Street 1:4 FLAGSHIP RD
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-4423
Practice Address - Country:US
Practice Address - Phone:206-331-6145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14113101YM0800X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician