Healthcare Provider Details

I. General information

NPI: 1104442524
Provider Name (Legal Business Name): ALEXANDER JAMES SYLVESTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 WALL ST STE 100
SEATTLE WA
98121-1431
US

IV. Provider business mailing address

222 WALL ST STE 100
SEATTLE WA
98121-1431
US

V. Phone/Fax

Practice location:
  • Phone: 206-441-3043
  • Fax:
Mailing address:
  • Phone: 206-441-3043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG61086055
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: