Provider Demographics
NPI:1386020451
Name:MACDIARMID, ALEXIS RAE (LAC)
Entity Type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:RAE
Last Name:MACDIARMID
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-2510
Mailing Address - Country:US
Mailing Address - Phone:406-454-6973
Mailing Address - Fax:406-791-9277
Practice Address - Street 1:601 1ST AVE N
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-2510
Practice Address - Country:US
Practice Address - Phone:406-454-6973
Practice Address - Fax:406-791-9277
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-1318101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)