Provider Demographics
NPI:1972220051
Name:ALEXANDER, EMILY (LSW, CDCA)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LSW, CDCA
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:AMIDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SW-TRAINEE
Mailing Address - Street 1:212 E COLUMBUS AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2033
Mailing Address - Country:US
Mailing Address - Phone:937-599-1411
Mailing Address - Fax:
Practice Address - Street 1:212 E COLUMBUS AVE STE 1
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2033
Practice Address - Country:US
Practice Address - Phone:937-599-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YM0800X
OHS.2309407101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health