MEDICARE: SKYLAR JOY ALEXANDER LCSW, LCAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCAS-27448	NC
2	1041C0700X	Clinical Social Worker	C016606	NC

General Provider Information

NPI Number	:	1447920988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SKYLAR JOY ALEXANDER LCSW, LCAS

Provider Business Mailing Address
First Line	:	7 PROFESSIONAL DR
Second Line	:
City	:	SNOW HILL
State	:	NC
Zip	:	28580-1332
Country	:	US
Telephone Number	:	252-747-8162
Fax Number	:	252-747-8163

Provider Business Practice Location Address
First Line	:	205 MARTIN L KING JR PKWY
Second Line	:
City	:	SNOW HILL
State	:	NC
Zip	:	28580-1320
Country	:	US
Telephone Number	:	252-747-4199
Fax Number	:	252-221-5308

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2021
Last Update Date	:	05/07/2024

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