Healthcare Provider Details

I. General information

NPI: 1861633992
Provider Name (Legal Business Name): SOLUTIONS FOR EMPLOYEE ADVANCEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 A1A S STE 1 PMB 136
ST AUGUSTINE FL
32080-7425
US

IV. Provider business mailing address

4225 A1A S STE 1 PMB 136
ST AUGUSTINE FL
32080-7425
US

V. Phone/Fax

Practice location:
  • Phone: 904-302-7303
  • Fax:
Mailing address:
  • Phone: 904-302-7303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW5325
License Number StateFL

VIII. Authorized Official

Name: DR. DOLORES LEXANDRA
Title or Position: MANAGER
Credential: PH.D., LCSW
Phone: 954-647-5737