Healthcare Provider Details

I. General information

NPI: 1245965292
Provider Name (Legal Business Name): ALEC ROTHSCHILD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2022
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WINDING GAP RD
LAKE TOXAWAY NC
28747-8786
US

IV. Provider business mailing address

151 GREEN BRIAR LN # 2
BOONE NC
28607-7394
US

V. Phone/Fax

Practice location:
  • Phone: 800-975-7303
  • Fax:
Mailing address:
  • Phone: 610-348-3134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberROTH-K1RVTW
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: