Healthcare Provider Details

I. General information

NPI: 1063924967
Provider Name (Legal Business Name): ALEXANDRA HUSS LCSWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W 40TH ST STE 320
BALTIMORE MD
21211-2109
US

IV. Provider business mailing address

3800 TUDOR ARMS AVE APT 1
BALTIMORE MD
21211-2268
US

V. Phone/Fax

Practice location:
  • Phone: 443-585-4625
  • Fax:
Mailing address:
  • Phone: 443-585-4625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number23848
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: