Provider Demographics
NPI:1659140705
Name:ROSS, ALIXANDRA
Entity Type:Individual
Prefix:
First Name:ALIXANDRA
Middle Name:
Last Name:ROSS
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 1:1224 BELLRENG DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4016
Mailing Address - Country:US
Mailing Address - Phone:917-406-2242
Mailing Address - Fax:
Practice Address - Street 1:2231 E MILLBROOK RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1746
Practice Address - Country:US
Practice Address - Phone:919-307-8165
Practice Address - Fax:919-307-8167
Is Sole Proprietor?:No
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19450101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health