Healthcare Provider Details

I. General information

NPI: 1841894284
Provider Name (Legal Business Name): ANGELA ALEXANDER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 11/25/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1446 HAZEN ST SE
GRAND RAPIDS MI
49507-3713
US

IV. Provider business mailing address

1446 HAZEN ST SE
GRAND RAPIDS MI
49507-3713
US

V. Phone/Fax

Practice location:
  • Phone: 616-516-7740
  • Fax:
Mailing address:
  • Phone: 616-516-7740
  • 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:
Title or Position:
Credential:
Phone: