Provider Demographics
NPI:1295248318
Name:LAMBETH, ALEXANDRA HAWARDEN (LPC, CRC)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:HAWARDEN
Last Name:LAMBETH
Suffix:
Gender:F
Credentials:LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 542273
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-2273
Mailing Address - Country:US
Mailing Address - Phone:972-677-9210
Mailing Address - Fax:
Practice Address - Street 1:322 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3308
Practice Address - Country:US
Practice Address - Phone:972-677-9210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-11
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL00120337225C00000X
TX74529101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor