Healthcare Provider Details

I. General information

NPI: 1932960887
Provider Name (Legal Business Name): CYNTHIA SELLERS LASSITER LCAS-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N PINE ST
ABERDEEN NC
28315-2732
US

IV. Provider business mailing address

206 N PINE ST
ABERDEEN NC
28315-2732
US

V. Phone/Fax

Practice location:
  • Phone: 910-944-2189
  • Fax: 910-944-7443
Mailing address:
  • Phone: 910-944-2189
  • Fax: 910-944-7443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-20367
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: