Healthcare Provider Details

I. General information

NPI: 1770244923
Provider Name (Legal Business Name): ALEXIA FORD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2022
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 WAGON TRL
MANSFIELD GA
30055-4422
US

IV. Provider business mailing address

140 WAGON TRL
MANSFIELD GA
30055-4422
US

V. Phone/Fax

Practice location:
  • Phone: 770-371-6295
  • Fax:
Mailing address:
  • Phone: 770-371-6295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10052
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW008843
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW23165
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: