Provider Demographics
NPI:1194295873
Name:TURNER, LARIZA (LCAS-A)
Entity type:Individual
Prefix:MRS
First Name:LARIZA
Middle Name:
Last Name:TURNER
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9693 BRANDYBUCK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-7032
Mailing Address - Country:US
Mailing Address - Phone:704-241-5676
Mailing Address - Fax:
Practice Address - Street 1:9693 BRANDYBUCK DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-7032
Practice Address - Country:US
Practice Address - Phone:704-241-5676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23618101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty