Provider Demographics
NPI:1386192235
Name:MEJIA, ALEXANDRIA (MA; EDS)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:MEJIA
Suffix:
Gender:F
Credentials:MA; EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 N COURT ST
Mailing Address - Street 2:OFFICE OF SPECIAL PROGRAMS
Mailing Address - City:WAYNE
Mailing Address - State:WV
Mailing Address - Zip Code:25570-1141
Mailing Address - Country:US
Mailing Address - Phone:304-272-5116
Mailing Address - Fax:
Practice Address - Street 1:212 N COURT ST
Practice Address - Street 2:OFFICE OF SPECIAL PROGRAMS
Practice Address - City:WAYNE
Practice Address - State:WV
Practice Address - Zip Code:25570-1141
Practice Address - Country:US
Practice Address - Phone:304-272-5116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA8J139900159103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool