Provider Demographics
NPI:1932578663
Name:ALEXANDER, LUCRETIA DIANE (LCAS)
Entity type:Individual
Prefix:
First Name:LUCRETIA
Middle Name:DIANE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 KENNY WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-4437
Mailing Address - Country:US
Mailing Address - Phone:910-977-3363
Mailing Address - Fax:
Practice Address - Street 1:100 BILLINGSLEY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1002
Practice Address - Country:US
Practice Address - Phone:704-376-7447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NV04819-L101YA0400X
NC29811101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor