Healthcare Provider Details

I. General information

NPI: 1275454084
Provider Name (Legal Business Name): LALEITA NICOLE SMALL P024233
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505B COURT DR
GASTONIA NC
28054-2140
US

IV. Provider business mailing address

2505B COURT DR
GASTONIA NC
28054-2140
US

V. Phone/Fax

Practice location:
  • Phone: 980-320-8934
  • Fax: 980-320-8934
Mailing address:
  • Phone: 980-320-8934
  • Fax: 980-320-8934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP024233
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: