Provider Demographics
NPI:1235746025
Name:ALEXANDER JOLIVETTE, AUDREY (LPC-I)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:ALEXANDER JOLIVETTE
Suffix:
Gender:F
Credentials:LPC-I
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:ALEXANDER
Other - Last Name:JOLIVETTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10730 POTRANCO RD STE 122-475
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3327
Mailing Address - Country:US
Mailing Address - Phone:210-379-7313
Mailing Address - Fax:
Practice Address - Street 1:10730 POTRANCO RD STE 122-475
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3327
Practice Address - Country:US
Practice Address - Phone:210-379-7313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81969101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor