Healthcare Provider Details

I. General information

NPI: 1740797794
Provider Name (Legal Business Name): ALEXIS KATHOLIKI-ELENI SKOPOS BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 12/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 BUSINESS PARK BLVD
DAYTONA BEACH FL
32114-1230
US

IV. Provider business mailing address

146 E VOORHIS AVE APT 3
DELAND FL
32724-5951
US

V. Phone/Fax

Practice location:
  • Phone: 386-254-1931
  • Fax: 386-255-5818
Mailing address:
  • Phone: 330-980-0751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: