Healthcare Provider Details

I. General information

NPI: 1376354407
Provider Name (Legal Business Name): ALEXA FAITH HARRISON RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 TREE BLVD STE 6
ST AUGUSTINE FL
32084-5719
US

IV. Provider business mailing address

1750 TREE BLVD STE 6
ST AUGUSTINE FL
32084-5719
US

V. Phone/Fax

Practice location:
  • Phone: 904-206-7024
  • Fax:
Mailing address:
  • Phone: 904-206-7024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-406226
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: