Provider Demographics
NPI:1760099790
Name:STADLER, ALEXIS ANN (LCMHCA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ANN
Last Name:STADLER
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:ANN
Other - Last Name:GARBARINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6024 BRITANNIA BLVD
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-0281
Mailing Address - Country:US
Mailing Address - Phone:917-560-5974
Mailing Address - Fax:
Practice Address - Street 1:120 WAXHAW PROFESSIONAL DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173
Practice Address - Country:US
Practice Address - Phone:704-438-9901
Practice Address - Fax:704-943-4484
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18663101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health