Basic Information
| Provider Information | |||||||||
| NPI: | 1356562177 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALEXANDER | ||||||||
| FirstName: | CLYDE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D, LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4787 SHORELINE BLVD. | ||||||||
| Address2: | |||||||||
| City: | WATERFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484993655 | ||||||||
| FaxNumber: | 2483838081 | ||||||||
| Practice Location | |||||||||
| Address1: | 43996 WOODWARD AVENUE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | BLOOMFIELD HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483351711 | ||||||||
| FaxNumber: | 2483357950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 04/11/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801059815 | MI | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | 6801059815 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | 103TB0200X | 6801059815 | MI | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 101YA0400X | 6801059815 | MI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.