Provider Demographics
NPI:1962978734
Name:ANDERSON, ALEXANDRA ASHLEY
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ASHLEY
Last Name:ANDERSON
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 1:328 OLD FORGE LN APT 2109
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-2969
Mailing Address - Country:US
Mailing Address - Phone:443-745-3484
Mailing Address - Fax:
Practice Address - Street 1:328 OLD FORGE LN APT 2109
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-2969
Practice Address - Country:US
Practice Address - Phone:443-745-3484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician