Provider Demographics
NPI:1265157341
Name:CLIFTON, ALEXANDRIA MONIQUE
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:MONIQUE
Last Name:CLIFTON
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 1:4034 SHASTA CIR
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-6911
Mailing Address - Country:US
Mailing Address - Phone:704-620-5606
Mailing Address - Fax:
Practice Address - Street 1:1565 EBENEZER RD STE 116
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2494
Practice Address - Country:US
Practice Address - Phone:803-524-8346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health