1588138986 NPI number — LASHLEY RALEIGH LPC, NCC, LLC

Table of content: (NPI 1588138986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588138986 NPI number — LASHLEY RALEIGH LPC, NCC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LASHLEY RALEIGH LPC, NCC, LLC
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:
1588138986
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 COMMERCIAL DR STE C3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31406-3633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-777-2713
Provider Business Mailing Address Fax Number:
912-335-3927

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 COMMERCIAL DR STE C3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31406-3633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-777-2713
Provider Business Practice Location Address Fax Number:
912-335-3927
Provider Enumeration Date:
01/18/2019

Additional Information

Authorized Official

Authorized Official Last Name:
RALEIGH
Authorized Official First Name:
LASHLEY
Authorized Official Middle Name:
SUSANNE
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
912-777-2713

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: STHA233W1608 . This is a "ANTHEM BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com