Provider Demographics
NPI:1598195612
Name:ALEXANDER, EMILI-ERIN ELIZABETH (M ED)
Entity Type:Individual
Prefix:MS
First Name:EMILI-ERIN
Middle Name:ELIZABETH
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 SAN MARCO AVE
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-3268
Mailing Address - Country:US
Mailing Address - Phone:904-826-9395
Mailing Address - Fax:
Practice Address - Street 1:155 SAN MARCO AVE
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-3268
Practice Address - Country:US
Practice Address - Phone:904-826-9395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11772101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health