Healthcare Provider Details

I. General information

NPI: 1174445811
Provider Name (Legal Business Name): ALEX MOOTS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2049 SAVANNAH HWY STE D
CHARLESTON SC
29407-2228
US

IV. Provider business mailing address

721 TALISON AVE APT 101
DANIEL ISLAND SC
29492-6334
US

V. Phone/Fax

Practice location:
  • Phone: 843-507-2299
  • Fax:
Mailing address:
  • Phone: 860-806-2027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number107735590
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: