Healthcare Provider Details

I. General information

NPI: 1699191833
Provider Name (Legal Business Name): ALEXANDRIA SMITH-VASQUEZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 LLEWELLYN AVE
NORFOLK VA
23504-1203
US

IV. Provider business mailing address

639 RIVER BEND CT APT 302
NEWPORT NEWS VA
23602-7088
US

V. Phone/Fax

Practice location:
  • Phone: 727-205-2077
  • Fax:
Mailing address:
  • Phone: 757-344-4374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number0701012389
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: