Healthcare Provider Details

I. General information

NPI: 1962800573
Provider Name (Legal Business Name): PAMELA ELAINE LASSITER M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2014
Last Update Date: 04/19/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 3RD ST E
LEESBURG GA
31763-4316
US

IV. Provider business mailing address

104 3RD ST E
LEESBURG GA
31763-4316
US

V. Phone/Fax

Practice location:
  • Phone: 229-947-1009
  • Fax: 229-874-1661
Mailing address:
  • Phone: 229-947-1009
  • Fax: 229-874-1661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC010989
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLPC010989
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC010989
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH21783
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9519
License Number StateCT
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC010989
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: