Healthcare Provider Details

I. General information

NPI: 1114400223
Provider Name (Legal Business Name): ALEXANDRA RAYMOND BA, CAA, MA-INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 S ANGELINE ST
SEATTLE WA
98118-1712
US

IV. Provider business mailing address

29307 45TH PL S
AUBURN WA
98001-1521
US

V. Phone/Fax

Practice location:
  • Phone: 206-461-4880
  • Fax:
Mailing address:
  • Phone: 253-332-6976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: