Healthcare Provider Details

I. General information

NPI: 1740117530
Provider Name (Legal Business Name): ALEXANDRA VICTORIAYEVGENIYEVNA GOROKHOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA AURORA-DIOR JEYE

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BULL ST STE 200
SAVANNAH GA
31401-3378
US

IV. Provider business mailing address

100 BULL ST STE 200
SAVANNAH GA
31401-3378
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-532912
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: