Provider Demographics
NPI:1518549450
Name:HARLEY, ALEXIS RAE (MS, LPC, NCC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:RAE
Last Name:HARLEY
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 S LIVE OAK DR
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-7215
Mailing Address - Country:US
Mailing Address - Phone:843-879-1421
Mailing Address - Fax:
Practice Address - Street 1:1714 S LIVE OAK DR
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-7215
Practice Address - Country:US
Practice Address - Phone:843-879-1421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7783101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor