Provider Demographics
NPI:1124517297
Name:PARKER, ALEXANDRA DANIELLE (CDCA 167139)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:DANIELLE
Last Name:PARKER
Suffix:
Gender:F
Credentials:CDCA 167139
Other - Prefix:MS
Other - First Name:ALEXANDRA
Other - Middle Name:DANIELLE
Other - Last Name:BAZELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDCA
Mailing Address - Street 1:117 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1403
Mailing Address - Country:US
Mailing Address - Phone:740-237-4981
Mailing Address - Fax:877-325-2816
Practice Address - Street 1:117 N 4TH ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1403
Practice Address - Country:US
Practice Address - Phone:740-237-4981
Practice Address - Fax:877-325-2816
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
QMHS101YM0800X
171M00000X
OHCDCA.167139101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0309440Medicaid
OH2144067Medicaid