Healthcare Provider Details

I. General information

NPI: 1114852514
Provider Name (Legal Business Name): ALEXA MCCORMACK LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203B WESTPORT DR
CABOT AR
72023-3657
US

IV. Provider business mailing address

203B WESTPORT DR
CABOT AR
72023-3657
US

V. Phone/Fax

Practice location:
  • Phone: 501-843-9233
  • Fax: 501-843-9656
Mailing address:
  • Phone: 501-843-9233
  • Fax: 501-843-9656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP2
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: