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General NPI Number Information
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NPI Number | 1427446947
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Entity Type | Individual
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Provider Name | ALEXANDRA IVANOVSKY STOBAUGH LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/06/2015
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Last Update Date | 09/13/2025
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Provider Practice Location Address
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Address Line | 6731 SHOO FLY RD
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City | PLACERVILLE
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State | CA
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Zip | 95667-7421
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Country | US
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Telephone | 530-363-8681
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1403
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City | PLACERVILLE
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State | CA
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Zip | 95667-1403
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Country | US
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Telephone | 530-363-8681
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 25034
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 25034
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 25034
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 25034
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License Number State | CA
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