Provider Demographics
NPI:1114665916
Name:LAKE NORMAN PSYCHOLOGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:LAKE NORMAN PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:LAKE NORMAN PSYCHOLOGICAL SERVICES PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:SADOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-677-2652
Mailing Address - Street 1:9820 NORTHCROSS CENTER CT STE 210
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7356
Mailing Address - Country:US
Mailing Address - Phone:704-677-2652
Mailing Address - Fax:
Practice Address - Street 1:9820 NORTHCROSS CENTER CT STE 210
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7356
Practice Address - Country:US
Practice Address - Phone:704-677-2652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty