MEDICARE: ALEXANDRIA TACKETT SONES LCSW, MCAP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW16698	FL

General Provider Information

NPI Number	:	1538789821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRIA TACKETT SONES LCSW, MCAP

Provider Business Mailing Address
First Line	:	356 NW AVENS ST
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-1614
Country	:	US
Telephone Number	:	502-510-6113
Fax Number	:

Provider Business Practice Location Address
First Line	:	2449 SW FALCON CIR UNIT 292
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-2923
Country	:	US
Telephone Number	:	502-510-6113
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2020
Last Update Date	:	03/22/2022

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