=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083176796
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES F LASSITER PHD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2019
-----------------------------------------------------
Last Update Date | 08/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2006 OLD GREENBRIER ROAD SUITE 12
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23320-2648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-228-5635
-----------------------------------------------------
Fax | 757-233-0327
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2006 OLD GREENBRIER ROAD SUITE 12
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23320-2648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-228-5635
-----------------------------------------------------
Fax | 757-233-0327
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JAMES F LASSITER
-----------------------------------------------------
Credential | PHD, ABPP
-----------------------------------------------------
Telephone | 757-228-5635
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------