Provider Demographics
NPI:1063529709
Name:KRISTEVSKI, ALEXANDER C (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:C
Last Name:KRISTEVSKI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2834 PAINTED LEAF DR
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8132
Mailing Address - Country:US
Mailing Address - Phone:219-365-3960
Mailing Address - Fax:
Practice Address - Street 1:9330 S BROADWAY
Practice Address - Street 2:ABJ-VA OUTPATIENT CLINIC
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307
Practice Address - Country:US
Practice Address - Phone:219-662-5098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008595103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical