Provider Demographics
NPI:1891330189
Name:ALEXANDRE, KETSIA
Entity Type:Individual
Prefix:
First Name:KETSIA
Middle Name:
Last Name:ALEXANDRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 HAMILTON BRANCH CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-0069
Mailing Address - Country:US
Mailing Address - Phone:321-695-5623
Mailing Address - Fax:
Practice Address - Street 1:2401 HAMILTON BRANCH CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-0069
Practice Address - Country:US
Practice Address - Phone:321-695-5623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health