=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124395181
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALIXANDRA NICOLE RAYMOND M.S., BCBA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2011
-----------------------------------------------------
Last Update Date | 12/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 CENTRAL PLAZA #101
-----------------------------------------------------
City | ROME
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30161-3230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-832-6727
-----------------------------------------------------
Fax | 772-675-9100
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1980 OLD CEDARTOWN RD
-----------------------------------------------------
City | CEDARTOWN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30125-5082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-787-8039
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | LBA000272
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------