Individual
ALEXANDRA BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1412 PROVIDENCE RD, CHARLOTTE, NC 28207-2543
(704) 714-6981
Mailing address
1412 PROVIDENCE RD, CHARLOTTE, NC 28207-2543
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C004026
NC
Other
Enumeration date
06/11/2024
Last updated
06/11/2024
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