Basic Information
| Provider Information | |||||||||
| NPI: | 1659007987 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONTIE | ||||||||
| FirstName: | ALXANDRA | ||||||||
| MiddleName: | RAE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A.ED. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6075 LEE HWY | ||||||||
| Address2: | |||||||||
| City: | TROUTVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241755889 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3716 MELROSE AVE NW | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240172716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403620360 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2022 | ||||||||
| LastUpdateDate: | 07/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 0704015045 | VA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.