Provider Demographics
NPI:1255544151
Name:WALLACE, ALEXIS A (LCMHC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:A
Last Name:WALLACE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COUNSELING SOLUTIONS
Mailing Address - Street 2:80 PALOMINO LANE, SUITE 203
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110
Mailing Address - Country:US
Mailing Address - Phone:603-627-8858
Mailing Address - Fax:
Practice Address - Street 1:COUNSELING SOLUTIONS
Practice Address - Street 2:80 PALOMINO LANE, SUITE 203
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110
Practice Address - Country:US
Practice Address - Phone:603-627-8858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH160101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010002Medicaid