Healthcare Provider Details

I. General information

NPI: 1679210611
Provider Name (Legal Business Name): ALEX CHI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12345 WAKE FOREST RD STE 2B
CLARKSVILLE MD
21029-1561
US

IV. Provider business mailing address

1163 WASHINGTON BLVD
BALTIMORE MD
21230-1824
US

V. Phone/Fax

Practice location:
  • Phone: 443-339-6567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP18303
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: