Provider Demographics
NPI:1922979384
Name:WATERS, LEEXANDRA M (BA)
Entity type:Individual
Prefix:
First Name:LEEXANDRA
Middle Name:M
Last Name:WATERS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 OAKMONT DR
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-9323
Mailing Address - Country:US
Mailing Address - Phone:864-582-7588
Mailing Address - Fax:864-562-4117
Practice Address - Street 1:129 DILLON DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1017
Practice Address - Country:US
Practice Address - Phone:864-582-7588
Practice Address - Fax:864-562-4117
Is Sole Proprietor?:No
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)