Healthcare Provider Details

I. General information

NPI: 1407711674
Provider Name (Legal Business Name): ALEKSANDRA ANDIC VILLEPIQUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 3222
BIG BEAR CITY CA
92314-3222
US

IV. Provider business mailing address

PO BOX 3222
BIG BEAR CITY CA
92314-3222
US

V. Phone/Fax

Practice location:
  • Phone: 909-273-1797
  • Fax:
Mailing address:
  • Phone: 909-273-1797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberAPCC20899
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT158920
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: