Provider Demographics
NPI:1447929286
Name:LONGMORE, ALEXXIS (M ED, LCMHC-A)
Entity type:Individual
Prefix:
First Name:ALEXXIS
Middle Name:
Last Name:LONGMORE
Suffix:
Gender:F
Credentials:M ED, LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4728 PARK RD STE C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3376
Mailing Address - Country:US
Mailing Address - Phone:704-523-5567
Mailing Address - Fax:
Practice Address - Street 1:4728 PARK RD STE C
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3376
Practice Address - Country:US
Practice Address - Phone:704-523-5567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A16781OtherNO INSURANCE