Provider Demographics
NPI:1952993297
Name:ALEXANDER, SHAVON R
Entity Type:Individual
Prefix:
First Name:SHAVON
Middle Name:R
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 1:36875 MCKINNEY AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-1373
Mailing Address - Country:US
Mailing Address - Phone:313-844-1557
Mailing Address - Fax:
Practice Address - Street 1:27780 NOVI RD STE 244
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3427
Practice Address - Country:US
Practice Address - Phone:313-437-7762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical