Basic Information
| Provider Information | |||||||||
| NPI: | 1265078075 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUEY-GOMEZ | ||||||||
| FirstName: | ALEXANDRIA | ||||||||
| MiddleName: | KENYE | ||||||||
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| Credential: | LCSW-A, LCAS-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18 WEDGEFIELD DR | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288062226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282528748 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 18 WEDGEFIELD DR | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288062226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282528748 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2019 | ||||||||
| LastUpdateDate: | 11/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | P013601 | NC | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YA0400X | LCAS-25628 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.