Provider Demographics
NPI:1194597153
Name:COLETTA, ALEXANDRA MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:MARIE
Last Name:COLETTA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9321 BRUNDIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3404
Mailing Address - Country:US
Mailing Address - Phone:609-827-2927
Mailing Address - Fax:
Practice Address - Street 1:312 BROWNS HILL CT
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-9511
Practice Address - Country:US
Practice Address - Phone:804-893-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810008261103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical