Provider Demographics
NPI:1033091640
Name:VICCHIO, ALEXIS MARIE (MS)
Entity type:Individual
Prefix:MISS
First Name:ALEXIS
Middle Name:MARIE
Last Name:VICCHIO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:LEXIE
Other - Middle Name:MARIE
Other - Last Name:VICCHIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:43710 MINK MEADOWS ST
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-3629
Mailing Address - Country:US
Mailing Address - Phone:703-389-3723
Mailing Address - Fax:
Practice Address - Street 1:13655 DULLES TECHNOLOGY DR STE 120
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4634
Practice Address - Country:US
Practice Address - Phone:571-665-4025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA25-165221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist