Provider Demographics
NPI:1245965292
Name:ROTHSCHILD, ALEC
Entity type:Individual
Prefix:
First Name:ALEC
Middle Name:
Last Name:ROTHSCHILD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 GREEN BRIAR LN # 2
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-7394
Mailing Address - Country:US
Mailing Address - Phone:610-348-3134
Mailing Address - Fax:
Practice Address - Street 1:500 WINDING GAP RD
Practice Address - Street 2:
Practice Address - City:LAKE TOXAWAY
Practice Address - State:NC
Practice Address - Zip Code:28747-8786
Practice Address - Country:US
Practice Address - Phone:800-975-7303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCROTH-K1RVTW101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health