Provider Demographics
NPI:1912420688
Name:VANCE, ALEXANDRA (MA, LMHC)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:VANCE
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 MINOR AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2825
Mailing Address - Country:US
Mailing Address - Phone:206-590-0523
Mailing Address - Fax:
Practice Address - Street 1:1204 MINOR AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2825
Practice Address - Country:US
Practice Address - Phone:206-590-0523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-24
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61481654101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health