Healthcare Provider Details

I. General information

NPI: 1265981393
Provider Name (Legal Business Name): ALEXANDRA LJUBIC LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8623 N WAYNE RD STE 104
WESTLAND MI
48185-1137
US

IV. Provider business mailing address

8623 N WAYNE RD
WESTLAND MI
48185-1137
US

V. Phone/Fax

Practice location:
  • Phone: 734-742-0191
  • Fax: 734-793-5312
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801099764
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: