Individual
ALEXIS ARIELLE ETHRIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, RMHCI
Contact information
Practice address
1530 CORNERSTONE BLVD, DAYTONA BEACH, FL 32117-7128
(904) 855-9169
Mailing address
3606 GRUNTHAL ST, JACKSONVILLE, FL 32209-3807
(904) 537-4621
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
IMH26000
FL
Other
Enumeration date
07/03/2024
Last updated
07/03/2024
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