Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1124650015 |
---|---|
Provider Name | Alexandra Wilcox |
First Address | Henderson, NV 89002-5137 |
Second Address | Henderson, NV 89002-5137 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2020 |
Last Update Date | 07/02/2020 |