Individual
ALEXIS C IRVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
705 E MAIN ST, WYTHEVILLE, VA 24382-3301
(276) 617-2103
Mailing address
2138 CASTLETON RD, MAX MEADOWS, VA 24360-3141
(276) 617-2103
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/01/2022
Last updated
02/01/2022
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