Basic Information
Provider Information
NPI: 1396101739
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LESNOFF
FirstName: ALEXANDREA
MiddleName: ELMORE
NamePrefix: MRS.
NameSuffix:  
Credential: LCSWA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: ELMORE
OtherFirstName: ALEXANDREA
OtherMiddleName: LEIGH
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: LCSWA
OtherLastNameType: 1
Mailing Information
Address1: 284 EXECUTIVE PARK DR STE 100
Address2:  
City: CONCORD
State: NC
PostalCode: 280251833
CountryCode: US
TelephoneNumber: 7049391100
FaxNumber: 7049391173
Practice Location
Address1: 5841 US 421 S
Address2:  
City: LILLINGTON
State: NC
PostalCode: 275466713
CountryCode: US
TelephoneNumber: 9108935727
FaxNumber: 9108936404
Other Information
ProviderEnumerationDate: 01/14/2016
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XP009902NCY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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