1700330867 NPI number — GARNER LIGHTHOUSE

Table of content: LAKEISHA JUNA JOHNSON LMSW (NPI 1043059033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700330867 NPI number — GARNER LIGHTHOUSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARNER LIGHTHOUSE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700330867
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
607 BENSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARNER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27529-3988
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-594-1354
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
607 BENSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARNER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27529-3988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-594-1354
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/06/2016

Additional Information

Authorized Official

Authorized Official Last Name:
DOSHI
Authorized Official First Name:
USHA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
919-594-1354

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  13460 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 13460 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1436218 . This is a "NORTH CAROLINA SECRETARY OF STATE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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