Healthcare Provider Details

I. General information

NPI: 1578322400
Provider Name (Legal Business Name): ALEXIS VICTORIA IRENE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS VICTORIA PRAVDIUK

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 SPRING ST # 5029
PRINCETON NJ
08542-6901
US

IV. Provider business mailing address

3 TIMBER ROCK TRL
BERNARDSVILLE NJ
07924-2260
US

V. Phone/Fax

Practice location:
  • Phone: 609-200-6081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01008300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: