Healthcare Provider Details

I. General information

NPI: 1467315507
Provider Name (Legal Business Name): ALEXANDRIA COSCORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7491 MOSSDALE WAY
COLUMBUS GA
31909-1787
US

IV. Provider business mailing address

1 CYPRESS PT W
PENSACOLA FL
32514-7930
US

V. Phone/Fax

Practice location:
  • Phone: 850-293-1575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: