Healthcare Provider Details

I. General information

NPI: 1659697811
Provider Name (Legal Business Name): GISELLE KU'ULEIMOMI ALEXANDER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4980 LAKESHORE RD
LEXINGTON MI
48450-9379
US

IV. Provider business mailing address

4980 LAKESHORE RD
LEXINGTON MI
48450-9379
US

V. Phone/Fax

Practice location:
  • Phone: 512-809-8109
  • Fax:
Mailing address:
  • Phone: 512-809-8109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number70820
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number50917
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: