Healthcare Provider Details

I. General information

NPI: 1700284049
Provider Name (Legal Business Name): SHIRLEY ALEXANDER MS, CAC-AD, CAD-AS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2014
Last Update Date: 12/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 W PULASKI HWY
ELKTON MD
21921-5910
US

IV. Provider business mailing address

1103 GLEMSFORD RD APT L
ESSEX MD
21221-5547
US

V. Phone/Fax

Practice location:
  • Phone: 443-485-6544
  • Fax: 443-485-6442
Mailing address:
  • Phone: 862-262-5492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number671
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: