Provider Demographics
NPI:1346655891
Name:DEESE, LISETTE JENEE-MOORE (LCSWA, LCAS)
Entity type:Individual
Prefix:
First Name:LISETTE
Middle Name:JENEE-MOORE
Last Name:DEESE
Suffix:
Gender:F
Credentials:LCSWA, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4542 RAEFORD RD STE A11
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-0076
Mailing Address - Country:US
Mailing Address - Phone:919-418-9562
Mailing Address - Fax:800-799-3010
Practice Address - Street 1:10130 PERIMETER PKWY
Practice Address - Street 2:STE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-2447
Practice Address - Country:US
Practice Address - Phone:888-849-7379
Practice Address - Fax:855-857-7333
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3301101YA0400X
NCC0100491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)