Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | AL74086 | FL |
NPI | 1073078754 |
---|---|
Provider Name | Dr. Sean Alexander |
First Address | Jacksonville, FL 32256-8473 |
Second Address | Jacksonville, FL 32256-8473 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2019 |
Last Update Date | 06/02/2019 |