Provider Demographics
NPI:1558054460
Name:ANGELILLO, ALEXANDRIA (RBT)
Entity Type:Individual
Prefix:MISS
First Name:ALEXANDRIA
Middle Name:
Last Name:ANGELILLO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 N OAK ST BLDG A1
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-5901
Mailing Address - Country:US
Mailing Address - Phone:229-474-4384
Mailing Address - Fax:229-598-0557
Practice Address - Street 1:2704 N OAK ST BLDG A1
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-5901
Practice Address - Country:US
Practice Address - Phone:229-474-4384
Practice Address - Fax:229-598-0557
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-23-276056106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician