MEDICARE: MS. PATSY GARDNER ALEXANDER MSW LISW-CP

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	101Y00000X	Counselor	5455	SC
2	104100000X	Social Worker	5455	SC
3	1041C0700X	Clinical Social Worker	5455	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609032630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATSY GARDNER ALEXANDER MSW LISW-CP

Provider Business Mailing Address
First Line	:	1203 48TH AVE N
Second Line	:	UNIT 202
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5425
Country	:	US
Telephone Number	:	843-449-3086
Fax Number	:	843-449-6851

Provider Business Practice Location Address
First Line	:	1203 48TH AVE N
Second Line	:	UNIT 202
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5425
Country	:	US
Telephone Number	:	843-449-3086
Fax Number	:	843-449-6851

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

Provider Enumeration Date	:	07/30/2008
Last Update Date	:	03/31/2015

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