Healthcare Provider Details

I. General information

NPI: 1184048555
Provider Name (Legal Business Name): ALEXANDRA MARIE LANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA MARIE SCULLION LMHC, MS, CAS

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 ROWENA DR
CAMILLUS NY
13031-2331
US

IV. Provider business mailing address

114 ROWENA DR
CAMILLUS NY
13031-2331
US

V. Phone/Fax

Practice location:
  • Phone: 315-952-4255
  • Fax:
Mailing address:
  • Phone: 315-952-4255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number564396601
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: