Provider Demographics
NPI:1932855095
Name:DOUGLAS, ALEXANDER SMITH (ASW)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:SMITH
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 PACIFIC AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5797
Mailing Address - Country:US
Mailing Address - Phone:310-985-9895
Mailing Address - Fax:
Practice Address - Street 1:3191 CASITAS AVE STE 157
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-2470
Practice Address - Country:US
Practice Address - Phone:323-627-7020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1067911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical