Provider Demographics
NPI:1114690070
Name:PETERS, ALEXA JANET (BS, BS, RBT)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:JANET
Last Name:PETERS
Suffix:
Gender:F
Credentials:BS, BS, RBT
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:JANET
Other - Last Name:NOSAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, BS, RBT
Mailing Address - Street 1:1500 S DOUGLAS RD STE 230
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4108
Mailing Address - Country:US
Mailing Address - Phone:844-854-1116
Mailing Address - Fax:305-846-9711
Practice Address - Street 1:1630 BRAEBURN DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7371
Practice Address - Country:US
Practice Address - Phone:540-588-9582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-21-164998106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician