Healthcare Provider Details

I. General information

NPI: 1225899164
Provider Name (Legal Business Name): ALEXIS RUVALCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 FARMINGDALE DR
CHARLOTTE NC
28212-5551
US

IV. Provider business mailing address

1516 EDGEWATER DR
CHARLOTTE NC
28210-5213
US

V. Phone/Fax

Practice location:
  • Phone: 704-910-5810
  • Fax:
Mailing address:
  • Phone: 980-202-8079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA19600
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: