Provider Demographics
NPI:1043883796
Name:MOTT, ALEXANDRA (MED, EDS, LPC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:MOTT
Suffix:
Gender:F
Credentials:MED, EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 AUGUSTA ST STE 400
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-6509
Mailing Address - Country:US
Mailing Address - Phone:864-660-3453
Mailing Address - Fax:
Practice Address - Street 1:1990 AUGUSTA ST STE 400
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-6509
Practice Address - Country:US
Practice Address - Phone:864-660-3453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health