Healthcare Provider Details

I. General information

NPI: 1154235182
Provider Name (Legal Business Name): ALESHA BLAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S HARBOR CITY BLVD STE 401
MELBOURNE FL
32901-1389
US

IV. Provider business mailing address

2951 FONTAINEBLEAU AVE SE
PALM BAY FL
32909-8362
US

V. Phone/Fax

Practice location:
  • Phone: 321-259-1662
  • Fax:
Mailing address:
  • Phone: 772-643-7702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: