Provider Demographics
NPI:1881484921
Name:KETCHERSID, ALEXANDRIA VICTORIA (RCSWI)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:VICTORIA
Last Name:KETCHERSID
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2613
Mailing Address - Country:US
Mailing Address - Phone:407-415-8582
Mailing Address - Fax:
Practice Address - Street 1:2240 TWELVE OAKS WAY STE 102
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6970
Practice Address - Country:US
Practice Address - Phone:813-713-9402
Practice Address - Fax:888-428-5910
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10283101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health