Healthcare Provider Details

I. General information

NPI: 1972070886
Provider Name (Legal Business Name): SHAVIER ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5680 FULTON INDUSTRIAL BLVD SW
ATLANTA GA
30336-2659
US

IV. Provider business mailing address

5680 FULTON INDUSTRIAL BLVD SW
ATLANTA GA
30336-2659
US

V. Phone/Fax

Practice location:
  • Phone: 404-346-3471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH22854
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: