Provider Demographics
NPI:1598192403
Name:AZEVEDO, ALEXANDRA T (MS, NCC, LMHC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:T
Last Name:AZEVEDO
Suffix:
Gender:F
Credentials:MS, NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6735 CONROY RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-3565
Mailing Address - Country:US
Mailing Address - Phone:561-866-9246
Mailing Address - Fax:
Practice Address - Street 1:6735 CONROY RD
Practice Address - Street 2:SUITE 207
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3565
Practice Address - Country:US
Practice Address - Phone:561-866-9246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-09
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13728101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health