Provider Demographics
NPI:1568265908
Name:ALEXANDER, SHEREE NICHOLE
Entity type:Individual
Prefix:
First Name:SHEREE
Middle Name:NICHOLE
Last Name:ALEXANDER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SHEREE
Other - Middle Name:
Other - Last Name:MANNS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BEHAVIOR TECHICIAN
Mailing Address - Street 1:836 KERNER AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-5345
Mailing Address - Country:US
Mailing Address - Phone:540-819-0225
Mailing Address - Fax:
Practice Address - Street 1:1332 PLANTATION RD NE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-5713
Practice Address - Country:US
Practice Address - Phone:540-725-1572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1336723337106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician