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General NPI Number Information
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NPI Number | 1346066099
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Entity Type | Organization
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Legal Business Name | LAKESIDE CENTER FOR OCD & ANXIETY, LLC
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 403 E MAIN ST STE A
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City | LEXINGTON
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State | SC
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Zip | 29072-3603
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Country | US
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Telephone | 803-728-1168
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Fax | 803-728-3069
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Provider Business Mailing Address
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Address Line | 403 E MAIN ST STE A
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City | LEXINGTON
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State | SC
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Zip | 29072-3603
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Country | US
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Telephone | 803-728-1168
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Fax | 803-728-3069
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Authorized Official
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Title or Position | ITS MEMBER-MANAGER
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Name | NORA B SINCLAIR
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Credential | LPC
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Telephone | 803-728-1168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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