Healthcare Provider Details

I. General information

NPI: 1710502463
Provider Name (Legal Business Name): ALEXANDRA ELISE BLITZER HOLT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXANDRA BLITZER

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 MEADOWLARK DR
ALBANY GA
31707-3119
US

IV. Provider business mailing address

513 MEADOWLARK DR
ALBANY GA
31707-3119
US

V. Phone/Fax

Practice location:
  • Phone: 719-229-1286
  • Fax:
Mailing address:
  • Phone: 719-229-1286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number7560
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number7560
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: