Healthcare Provider Details

I. General information

NPI: 1205426350
Provider Name (Legal Business Name): ALEXANDRA BARTH LCSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 W ILLINOIS AVE UNIT 115
SOUTHERN PINES NC
28387-5808
US

IV. Provider business mailing address

135 W ILLINOIS AVE UNIT 115
SOUTHERN PINES NC
28387-5808
US

V. Phone/Fax

Practice location:
  • Phone: 910-929-0375
  • Fax: 910-849-3633
Mailing address:
  • Phone: 910-929-0375
  • Fax: 910-849-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRA BARTH
Title or Position: OWNER/ORGANIZER
Credential: LCSW
Phone: 910-929-0375