Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 FENTRESS BLVD
DAYTONA BEACH FL
32114-1214
US

IV. Provider business mailing address

728 FENTRESS BLVD
DAYTONA BEACH FL
32114-1214
US

V. Phone/Fax

Practice location:
  • Phone: 386-272-7440
  • Fax:
Mailing address:
  • Phone: 386-272-7440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH21915
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: