Provider Demographics
NPI:1487128138
Name:MEJIA, ALEX MAURICIO (LCSW)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:MAURICIO
Last Name:MEJIA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 CANNISTER CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-1907
Mailing Address - Country:US
Mailing Address - Phone:703-221-3348
Mailing Address - Fax:703-221-0426
Practice Address - Street 1:15941 DONALD CURTIS DR STE 200
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-4257
Practice Address - Country:US
Practice Address - Phone:703-792-4900
Practice Address - Fax:703-792-5699
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040107291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical