Provider Demographics
NPI:1346066099
Name:LAKESIDE CENTER FOR OCD & ANXIETY, LLC
Entity type:Organization
Organization Name:LAKESIDE CENTER FOR OCD & ANXIETY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ITS MEMBER-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NORA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SINCLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:803-728-1168
Mailing Address - Street 1:403 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-3603
Mailing Address - Country:US
Mailing Address - Phone:803-728-1168
Mailing Address - Fax:803-728-3069
Practice Address - Street 1:403 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3603
Practice Address - Country:US
Practice Address - Phone:803-728-1168
Practice Address - Fax:803-728-3069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty