Healthcare Provider Details

I. General information

NPI: 1427768167
Provider Name (Legal Business Name): ALEXANDRA VICTORIA HERRMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 LONG POINT RD STE 105
MOUNT PLEASANT SC
29464-8000
US

IV. Provider business mailing address

550 LONG POINT RD STE 105
MT PLEASANT SC
29464-8000
US

V. Phone/Fax

Practice location:
  • Phone: 843-938-4639
  • Fax:
Mailing address:
  • Phone: 843-938-4639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12575
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: