Healthcare Provider Details

I. General information

NPI: 1275757718
Provider Name (Legal Business Name): LETIF R ALEXANDER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5927 DEXTER ST
ROMULUS MI
48174-1825
US

IV. Provider business mailing address

5927 DEXTER ST
ROMULUS MI
48174-1825
US

V. Phone/Fax

Practice location:
  • Phone: 734-444-8987
  • Fax:
Mailing address:
  • Phone: 734-444-8987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6802083378
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: