Provider Demographics
NPI:1538765839
Name:SURRATT, ALEXIS BRIANNA LOWE (LCMHC, LCASA)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:BRIANNA LOWE
Last Name:SURRATT
Suffix:
Gender:F
Credentials:LCMHC, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:845 CHURCH ST N STE 203
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4374
Practice Address - Country:US
Practice Address - Phone:704-316-5027
Practice Address - Fax:704-316-5028
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NC16075101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health