Provider Demographics
NPI:1619619467
Name:BLACKWELL, ALEXIS J
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:J
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3886 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:NC
Mailing Address - Zip Code:27370-8823
Mailing Address - Country:US
Mailing Address - Phone:336-307-9574
Mailing Address - Fax:
Practice Address - Street 1:3886 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:NC
Practice Address - Zip Code:27370-8823
Practice Address - Country:US
Practice Address - Phone:336-307-9574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst