Provider Demographics
NPI:1508608357
Name:ROBERTSON, ALEXANDER STONE
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:STONE
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 SAND CREEK HWY APT 705
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1207
Mailing Address - Country:US
Mailing Address - Phone:517-867-9885
Mailing Address - Fax:
Practice Address - Street 1:4673 WASHTENAW AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1301
Practice Address - Country:US
Practice Address - Phone:734-547-5009
Practice Address - Fax:734-215-1231
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)