Provider Demographics
NPI:1538919170
Name:GRETTER, ALEXANDRA (LCSWA)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:GRETTER
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CHARACTER DR
Mailing Address - Street 2:
Mailing Address - City:ROLESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27571-9384
Mailing Address - Country:US
Mailing Address - Phone:919-815-4707
Mailing Address - Fax:
Practice Address - Street 1:936 NORTHBROOK DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5518
Practice Address - Country:US
Practice Address - Phone:919-815-4707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0202791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty