Provider Demographics
NPI:1548889744
Name:ALEXANDRE, MIRSHA ETIENNE (LMHC, NCC)
Entity type:Individual
Prefix:
First Name:MIRSHA
Middle Name:ETIENNE
Last Name:ALEXANDRE
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14422 SHORESIDE WAY STE 110-271
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4938
Mailing Address - Country:US
Mailing Address - Phone:074-890-0193
Mailing Address - Fax:
Practice Address - Street 1:232 S DILLARD ST STE 220
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3510
Practice Address - Country:US
Practice Address - Phone:407-890-0193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-09
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT2425106H00000X
FLMH18506101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty