Provider Demographics
NPI:1326175001
Name:SANSBURY, LONNIE PETE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:PETE
Last Name:SANSBURY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1887
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28802-1887
Mailing Address - Country:US
Mailing Address - Phone:828-252-5350
Mailing Address - Fax:828-252-5305
Practice Address - Street 1:1 ZILLICOA ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-1038
Practice Address - Country:US
Practice Address - Phone:828-252-5350
Practice Address - Fax:828-252-5350
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1759103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000199Medicaid
NC04572OtherBCBS
NC2814193BMedicare ID - Type Unspecified