Healthcare Provider Details

I. General information

NPI: 1225640428
Provider Name (Legal Business Name): GILLIAN MARIE ALEXANDER MA, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 RICHMOND HWY STE 800
ARLINGTON VA
22202-3603
US

IV. Provider business mailing address

13807 SPRINGSTONE DR
CLIFTON VA
20124-2362
US

V. Phone/Fax

Practice location:
  • Phone: 571-257-3378
  • Fax:
Mailing address:
  • Phone: 518-694-6720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0704011864
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: