Provider Demographics
NPI:1073086880
Name:RICHARDSON, ALEXIS ELLEN (LPC)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ELLEN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 CENTURY DR APT 121F
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-1550
Mailing Address - Country:US
Mailing Address - Phone:304-231-7198
Mailing Address - Fax:
Practice Address - Street 1:300 COUCH LN
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-1997
Practice Address - Country:US
Practice Address - Phone:864-553-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7003101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional