Provider Demographics
NPI:1003438532
Name:LANCASTER, LAUTEASHA (MS)
Entity Type:Individual
Prefix:
First Name:LAUTEASHA
Middle Name:
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LAUTEASHA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MARRIED NAME
Mailing Address - Street 1:2465 VISTORIA DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-1579
Mailing Address - Country:US
Mailing Address - Phone:770-910-2753
Mailing Address - Fax:
Practice Address - Street 1:1755 WOODSTOCK RD STE 200
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2135
Practice Address - Country:US
Practice Address - Phone:770-910-2753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist