Provider Demographics
NPI:1740782929
Name:ROBERTS, ALEXANDRA L (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10513 JUDICIAL DR STE 301
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7528
Mailing Address - Country:US
Mailing Address - Phone:703-966-5173
Mailing Address - Fax:
Practice Address - Street 1:10513 JUDICIAL DR STE 301
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7528
Practice Address - Country:US
Practice Address - Phone:703-966-5173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
VA0701012153101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator