Provider Demographics
NPI:1104428408
Name:KUPOVITS-CAVINS, ALEXIS N (LMSW)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:N
Last Name:KUPOVITS-CAVINS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:K
Other - Last Name:CAVINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8765 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-9300
Mailing Address - Country:US
Mailing Address - Phone:734-847-3802
Mailing Address - Fax:734-847-3418
Practice Address - Street 1:8765 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TEMPERANCE
Practice Address - State:MI
Practice Address - Zip Code:48182-9300
Practice Address - Country:US
Practice Address - Phone:734-847-3802
Practice Address - Fax:734-847-3418
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011073851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical