Provider Demographics
NPI:1285104281
Name:WHICKER, ALEXANDRA THERESA (MA, LCMHC-A, ATR-BC)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:THERESA
Last Name:WHICKER
Suffix:
Gender:F
Credentials:MA, LCMHC-A, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:2611 GARDEN HILL DR APT 302
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6526
Mailing Address - Country:US
Mailing Address - Phone:609-816-3858
Mailing Address - Fax:
Practice Address - Street 1:417 N BLOUNT ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-1009
Practice Address - Country:US
Practice Address - Phone:609-816-3858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02261-1221700000X
NCA16280101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist