Healthcare Provider Details

I. General information

NPI: 1386192235
Provider Name (Legal Business Name): ALEXANDRIA MEJIA M.A.; ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 N COURT ST OFFICE OF SPECIAL PROGRAMS
WAYNE WV
25570-1141
US

IV. Provider business mailing address

212 N COURT ST OFFICE OF SPECIAL PROGRAMS
WAYNE WV
25570-1141
US

V. Phone/Fax

Practice location:
  • Phone: 304-272-5116
  • Fax:
Mailing address:
  • Phone: 304-272-5116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberA8J139900159
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: