Healthcare Provider Details

I. General information

NPI: 1861302838
Provider Name (Legal Business Name): ALEXIS CHEYENNE JEWELL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 REYNOLDS AVE STE 201
NORTH CHARLESTON SC
29405-5868
US

IV. Provider business mailing address

2000 REYNOLDS AVE STE 201
NORTH CHARLESTON SC
29405-5868
US

V. Phone/Fax

Practice location:
  • Phone: 843-619-7536
  • Fax:
Mailing address:
  • Phone: 843-619-7536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12645
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: