Provider Demographics
NPI:1932229804
Name:PUGH, LERRICAS
Entity type:Individual
Prefix:MR
First Name:LERRICAS
Middle Name:
Last Name:PUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10404 PLANTERS VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-0042
Mailing Address - Country:US
Mailing Address - Phone:704-287-2438
Mailing Address - Fax:704-644-3917
Practice Address - Street 1:10404 PLANTERS VIEW DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-0042
Practice Address - Country:US
Practice Address - Phone:704-287-2438
Practice Address - Fax:704-644-3917
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5557101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional