Provider Demographics
NPI:1487395299
Name:DANIELS, ALEXANDRA (MA, LCMHCA)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MA, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 812 BOX 813
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09627-0009
Mailing Address - Country:US
Mailing Address - Phone:801-510-7703
Mailing Address - Fax:
Practice Address - Street 1:402 E RAINTREE LN
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-8261
Practice Address - Country:US
Practice Address - Phone:919-429-9828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17424101Y00000X, 101YP2500X, 251S00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No251S00000XAgenciesCommunity/Behavioral Health