Provider Demographics
NPI:1386316883
Name:MASON CEASER, ALEXANDRA DOMINIQUE
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:DOMINIQUE
Last Name:MASON CEASER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 COUNTRY BREEZE CT
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-8408
Mailing Address - Country:US
Mailing Address - Phone:773-301-9874
Mailing Address - Fax:
Practice Address - Street 1:103 COUNTRY BREEZE CT
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-8408
Practice Address - Country:US
Practice Address - Phone:773-301-9874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-02
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0077611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical