Healthcare Provider Details

I. General information

NPI: 1598115586
Provider Name (Legal Business Name): ALEXANDRA JORDAN BOLLINGER MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA JORDAN HAYSON MSW, LCSW-A

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 07/18/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 DOCK ST
WILMINGTON NC
28401-4936
US

IV. Provider business mailing address

1452 LEWIS LANDING AVE
WILMINGTON NC
28405-4483
US

V. Phone/Fax

Practice location:
  • Phone: 910-254-9898
  • Fax: 910-254-9818
Mailing address:
  • Phone: 239-595-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP010565
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: