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General NPI Number Information
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NPI Number | 1023928165
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Entity Type | Organization
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Legal Business Name | TRUCKER'S LANE LLC
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Dates
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Enumeration Date | 09/10/2026
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Last Update Date | 09/10/2026
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Provider Practice Location Address
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Address Line | 1740 S MARTIN LUTHER KING JR AVE
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City | SALISBURY
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State | NC
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Zip | 28144-5601
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Country | US
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Telephone | 704-200-8751
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Fax |
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Provider Business Mailing Address
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Address Line | 1740 S MARTIN LUTHER KING JR AVE
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City | SALISBURY
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State | NC
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Zip | 28144-5601
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Country | US
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Telephone | 704-200-8751
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGING MEMBER
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Name | MS. LATASHA GIDDERON
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Credential | CPSS
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Telephone | 704-200-8751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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