Provider Demographics
NPI:1699323337
Name:YOUNG-RIVARD, ALEXANDREA ELIZABETH
Entity type:Individual
Prefix:
First Name:ALEXANDREA
Middle Name:ELIZABETH
Last Name:YOUNG-RIVARD
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 1:39141 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-2776
Mailing Address - Country:US
Mailing Address - Phone:586-215-7384
Mailing Address - Fax:
Practice Address - Street 1:39141 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-2776
Practice Address - Country:US
Practice Address - Phone:586-215-7384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016611101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional