Healthcare Provider Details

I. General information

NPI: 1598195612
Provider Name (Legal Business Name): EMILI-ERIN ELIZABETH ALEXANDER M. ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2013
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 SAN MARCO AVE
ST AUGUSTINE FL
32084-3268
US

IV. Provider business mailing address

155 SAN MARCO AVE
ST AUGUSTINE FL
32084-3268
US

V. Phone/Fax

Practice location:
  • Phone: 904-826-9395
  • Fax:
Mailing address:
  • Phone: 904-826-9395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH11772
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: