Healthcare Provider Details

I. General information

NPI: 1063089308
Provider Name (Legal Business Name): ALEXIS WARE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 ROYAL CREEK DR
LEXINGTON SC
29072-8237
US

IV. Provider business mailing address

188 ROYAL CREEK DR
LEXINGTON SC
29072-8237
US

V. Phone/Fax

Practice location:
  • Phone: 803-673-4116
  • Fax:
Mailing address:
  • Phone: 803-673-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-60180
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: