Provider Demographics
NPI:1629290366
Name:PHIPPS, ALEXANDRA MENA (PHD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:MENA
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3518 PARSONS RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-5110
Mailing Address - Country:US
Mailing Address - Phone:770-418-1529
Mailing Address - Fax:770-418-1529
Practice Address - Street 1:2312 PEACHFORD RD STE C
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-5823
Practice Address - Country:US
Practice Address - Phone:770-451-5912
Practice Address - Fax:770-457-3046
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAPSY001958103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral