Provider Demographics
NPI:1093361024
Name:CARSON, ALEXIS RAE (EDS, NCSP)
Entity Type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:RAE
Last Name:CARSON
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 LORRAINE C TURNER DRIVE PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266
Mailing Address - Country:US
Mailing Address - Phone:276-889-6500
Mailing Address - Fax:276-889-6508
Practice Address - Street 1:84 DR LORRAINE C. TURNER DR. RUSSELL COUNTY PUBLIC SCHO
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266
Practice Address - Country:US
Practice Address - Phone:276-889-6500
Practice Address - Fax:276-889-6508
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool