Provider Demographics
NPI:1194301333
Name:ACHESON, ALEXANDRA (EDS, LEP)
Entity type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:
Last Name:ACHESON
Suffix:
Gender:F
Credentials:EDS, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 MANHATTAN AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3715
Mailing Address - Country:US
Mailing Address - Phone:508-631-9240
Mailing Address - Fax:
Practice Address - Street 1:1028 MANHATTAN AVE APT 5
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-3715
Practice Address - Country:US
Practice Address - Phone:508-631-9240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3985103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty