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General NPI Number Information
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NPI Number | 1417464900
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Entity Type | Organization
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Legal Business Name | ST LAZARUS BEHAVIORAL HEALTH PC
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Dates
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Enumeration Date | 01/05/2018
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Last Update Date | 11/27/2018
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Provider Practice Location Address
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Address Line | 8401 MEDICAL PLAZA DR STE 355
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City | CHARLOTTE
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State | NC
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Zip | 28262-9718
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Country | US
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Telephone | 877-624-5802
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Fax | 888-974-1542
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Provider Business Mailing Address
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Address Line | 8401 MEDICAL PLAZA DR STE 355
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City | CHARLOTTE
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State | NC
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Zip | 28262-9718
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Country | US
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Telephone | 877-624-5802
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Fax | 888-974-1542
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MEKETA DEANS
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Credential |
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Telephone | 877-624-5802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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