Provider Demographics
NPI:1043574346
Name:ALTILIO, ALEXANDRA (LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:ALTILIO
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4422 E COLUMBUS DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33605-3233
Mailing Address - Country:US
Mailing Address - Phone:813-413-1067
Mailing Address - Fax:813-479-0425
Practice Address - Street 1:1463 OAKFIELD DR
Practice Address - Street 2:SUITE 113
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-3899
Practice Address - Country:US
Practice Address - Phone:813-413-1067
Practice Address - Fax:813-479-0425
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health