Provider Demographics
NPI:1558630988
Name:WARE, ALEXIS MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:MARIE
Last Name:WARE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 MIDDLE VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-2547
Mailing Address - Country:US
Mailing Address - Phone:530-830-1893
Mailing Address - Fax:
Practice Address - Street 1:4290 BELLS FERRY RD NW STE 134-2018
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7140
Practice Address - Country:US
Practice Address - Phone:530-830-1893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW006565101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional