Provider Demographics
NPI:1588138986
Name:LASHLEY RALEIGH LPC, NCC, LLC
Entity type:Organization
Organization Name:LASHLEY RALEIGH LPC, NCC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LASHLEY
Authorized Official - Middle Name:SUSANNE
Authorized Official - Last Name:RALEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:912-777-2713
Mailing Address - Street 1:315 COMMERCIAL DR STE C3
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3633
Mailing Address - Country:US
Mailing Address - Phone:912-777-2713
Mailing Address - Fax:912-335-3927
Practice Address - Street 1:315 COMMERCIAL DR STE C3
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3633
Practice Address - Country:US
Practice Address - Phone:912-777-2713
Practice Address - Fax:912-335-3927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GASTHA233W1608OtherANTHEM BLUE CROSS BLUE SHIELD