Provider Demographics
NPI:1083176796
Name:JAMES F LASSITER PHD PC
Entity Type:Organization
Organization Name:JAMES F LASSITER PHD PC
Other - Org Name:JAMES F LASSITER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:LASSITER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ABPP
Authorized Official - Phone:757-228-5635
Mailing Address - Street 1:2006 OLD GREENBRIER ROAD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2648
Mailing Address - Country:US
Mailing Address - Phone:757-228-5635
Mailing Address - Fax:757-233-0327
Practice Address - Street 1:2006 OLD GREENBRIER ROAD
Practice Address - Street 2:SUITE 12
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2648
Practice Address - Country:US
Practice Address - Phone:757-228-5635
Practice Address - Fax:757-233-0327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1851352496Medicaid