Provider Demographics
NPI:1063971661
Name:LONG-DANIELS, ALEXIS (MA, ALC, NCC)
Entity type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:
Last Name:LONG-DANIELS
Suffix:
Gender:F
Credentials:MA, ALC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4737 SUMMER PLACE PKWY
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3095
Mailing Address - Country:US
Mailing Address - Phone:404-405-7701
Mailing Address - Fax:
Practice Address - Street 1:1229 3RD AVE N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-1628
Practice Address - Country:US
Practice Address - Phone:205-910-4168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3229A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1090779OtherNCC
ALC3229AOtherALC