Provider Demographics
NPI:1104676014
Name:GENESI, ALEXA LEE (CADC-III)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:LEE
Last Name:GENESI
Suffix:
Gender:F
Credentials:CADC-III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7741
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91359-7741
Mailing Address - Country:US
Mailing Address - Phone:818-390-9444
Mailing Address - Fax:818-381-0007
Practice Address - Street 1:80 E HILLCREST DR STE 110
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4226
Practice Address - Country:US
Practice Address - Phone:818-390-9444
Practice Address - Fax:818-381-0007
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker