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General NPI Number Information
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NPI Number | 1790117919
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Entity Type | Individual
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Provider Name | ALEXANDRA JOY SCOTT
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Gender | Female
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Dates
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Enumeration Date | 07/30/2013
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Last Update Date | 06/04/2021
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Provider Practice Location Address
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Address Line | 100 BREWSTER BLVD
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City | CAMP LEJEUNE
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State | NC
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Zip | 28547-2575
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Country | US
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Telephone | 562-760-5735
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Fax |
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Provider Business Mailing Address
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Address Line | 3939 ATLANTIC AVE STE 108
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City | LONG BEACH
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State | CA
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Zip | 90807-3529
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Country | US
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Telephone |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 5469
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 32534
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License Number State | CA
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