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General NPI Number Information
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NPI Number | 1528312576
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Entity Type | Individual
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Provider Name | ALEXANDER AMU LCPC, CCMHC
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Gender | Male
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 841 POPLAR POINT LN
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City | LOGANVILLE
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State | GA
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Zip | 30052-4843
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Country | US
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Telephone | 773-981-0047
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Fax |
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Provider Business Mailing Address
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Address Line | 841 POPLAR POINT LN
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City | LOGANVILLE
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State | GA
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Zip | 30052-4843
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Country | US
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Telephone | 773-981-0047
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.007733
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180.007733
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License Number State | IL
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