Provider Demographics
NPI:1528048204
Name:HASTY, LEE M (MSW,LCSW)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:M
Last Name:HASTY
Suffix:
Gender:M
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5011
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-3521
Mailing Address - Country:US
Mailing Address - Phone:704-283-2900
Mailing Address - Fax:704-283-2999
Practice Address - Street 1:1501 N. CHARLOTTE AVE.
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-9998
Practice Address - Country:US
Practice Address - Phone:704-283-2900
Practice Address - Fax:704-283-2999
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0004881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10193OtherBCBS
NC6002308Medicaid
NC6002308Medicaid