Provider Demographics
NPI:1891856571
Name:DUFFY, ALEXANDRA HIATT (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:HIATT
Last Name:DUFFY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11220 ELM LN STE 203
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0450
Mailing Address - Country:US
Mailing Address - Phone:704-654-1970
Mailing Address - Fax:
Practice Address - Street 1:11220 ELM LN STE 203
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-0450
Practice Address - Country:US
Practice Address - Phone:704-654-1920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPSY5000163103TC0700X
NC3202103TC0700X
CAPSY20193103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046XWOtherBLUE CROSS BLUE SHIELD NC
NC600944Medicaid