Provider Demographics
NPI:1114711322
Name:ALEXANDER, ELVILIN
Entity type:Individual
Prefix:
First Name:ELVILIN
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2156 WOODDALE BLVD STE 750
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1404
Mailing Address - Country:US
Mailing Address - Phone:225-930-8058
Mailing Address - Fax:
Practice Address - Street 1:12913 DRIFTWOOD DR
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-4810
Practice Address - Country:US
Practice Address - Phone:504-947-7553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17792104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker