Healthcare Provider Details

I. General information

NPI: 1497056543
Provider Name (Legal Business Name): ALEXIS JORDAN TCHUISE LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2010
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W PRATT ST
BALTIMORE MD
21223-2679
US

IV. Provider business mailing address

1001 W PRATT ST
BALTIMORE MD
21223-2679
US

V. Phone/Fax

Practice location:
  • Phone: 410-962-7180
  • Fax: 410-962-7194
Mailing address:
  • Phone: 410-962-7180
  • Fax: 410-962-7194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC2879
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: