Provider Demographics
NPI:1417507013
Name:BUCKHEIT, ALEXIS (MSED)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:BUCKHEIT
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 JEFFERSON DAVIS HWY APT 607
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-3309
Mailing Address - Country:US
Mailing Address - Phone:631-681-1717
Mailing Address - Fax:
Practice Address - Street 1:1501 LEE HWY STE 130
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-1109
Practice Address - Country:US
Practice Address - Phone:631-681-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health