Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker |
NPI | 1003271198 |
---|---|
Provider Name | Nicole Rufina Alexander |
First Address | Conyers, GA 30013-2229 |
Second Address | Monroe, GA 30655-2172 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2015 |
Last Update Date | 22/04/2020 |