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NPI Code Detail

MEDICARE: SANDRA DENISE LASSITER

MEDICARE: SANDRA DENISE LASSITER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator
2172V00000XCommunity Health Worker
3251S00000XCommunity/Behavioral Health Agency
4261Q00000XClinic/Center
5175T00000XPeer Specialist2022-2799-01NC

General Provider Information

NPI Number : 1366171993
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA DENISE LASSITER
Provider Business Mailing Address
First Line : 1812 LIBERTY ST
Second Line :
City : DURHAM
State : NC
Zip : 27703-2271
Country : US
Telephone Number : 919-384-5758
Fax Number :
Provider Business Practice Location Address
First Line : 1812 LIBERTY ST
Second Line :
City : DURHAM
State : NC
Zip : 27703-2271
Country : US
Telephone Number : 919-384-5758
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2022
Last Update Date : 08/18/2022

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Directions to “ SANDRA DENISE LASSITER ” Practice Location

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