Healthcare Provider Details

I. General information

NPI: 1154955870
Provider Name (Legal Business Name): CHRISTINE SOUTH ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CORNING RD
CARY NC
27518-9229
US

IV. Provider business mailing address

812 HISTORIAN ST
RALEIGH NC
27603-3489
US

V. Phone/Fax

Practice location:
  • Phone: 919-431-7400
  • Fax:
Mailing address:
  • Phone: 336-207-1566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14025
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: