Healthcare Provider Details

I. General information

NPI: 1144842790
Provider Name (Legal Business Name): ALEXANDRA SOLANA ROA LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2020
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4241 JUTLAND DR STE 207
SAN DIEGO CA
92117-3653
US

IV. Provider business mailing address

PO BOX 1804
POWAY CA
92074-1804
US

V. Phone/Fax

Practice location:
  • Phone: 619-733-6414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC16623
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: