Healthcare Provider Details

I. General information

NPI: 1104400753
Provider Name (Legal Business Name): ALEXANDREA PARKER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 COVELL AVE NW
GRAND RAPIDS MI
49504-5936
US

IV. Provider business mailing address

320 COVELL AVE NW
GRAND RAPIDS MI
49504-5936
US

V. Phone/Fax

Practice location:
  • Phone: 616-805-9638
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDREA PARKER
Title or Position: OWNER/THERAPIST
Credential:
Phone: 616-805-9638