Healthcare Provider Details

I. General information

NPI: 1568327997
Provider Name (Legal Business Name): ALEXIS FAISON PHD, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39889 W GANLY WAY
MARICOPA AZ
85138-5939
US

IV. Provider business mailing address

39889 W GANLY WAY
MARICOPA AZ
85138-5939
US

V. Phone/Fax

Practice location:
  • Phone: 336-293-3218
  • Fax:
Mailing address:
  • Phone: 336-293-3218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLAC22485
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: