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General NPI Number Information
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NPI Number | 1497551600
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Entity Type | Individual
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Provider Name | ALEXIS HETRICK LCMHCA
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Gender | Female
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 615 DOUGLAS ST STE 500
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City | DURHAM
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State | NC
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Zip | 27705-6616
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Country | US
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Telephone | 919-908-9730
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Fax |
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Provider Business Mailing Address
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Address Line | 1295 BANDANA BLVD W SUITE 210
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City | ST PAUL
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State | MN
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Zip | 55108
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A21035
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License Number State | NC
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