MEDICARE: ALEXANDRA TULLOCH LCMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	12926	NC

General Provider Information

NPI Number	:	1467987735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA TULLOCH LCMHC

Provider Business Mailing Address
First Line	:	4224 AUTUMN FROST TRL
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-7085
Country	:	US
Telephone Number	:	704-326-6222
Fax Number	:

Provider Business Practice Location Address
First Line	:	4412 PARK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3130
Country	:	US
Telephone Number	:	980-217-6901
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2017
Last Update Date	:	02/03/2026

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