Provider Demographics
NPI:1326278946
Name:LAKE AREA COUNSELING, INC.
Entity Type:Organization
Organization Name:LAKE AREA COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:BLACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:252-456-6541
Mailing Address - Street 1:519 WALKER AVE
Mailing Address - Street 2:
Mailing Address - City:NORLINA
Mailing Address - State:NC
Mailing Address - Zip Code:27563-9791
Mailing Address - Country:US
Mailing Address - Phone:252-456-6541
Mailing Address - Fax:252-456-6541
Practice Address - Street 1:519 WALKER AVE
Practice Address - Street 2:
Practice Address - City:NORLINA
Practice Address - State:NC
Practice Address - Zip Code:27563-9791
Practice Address - Country:US
Practice Address - Phone:252-456-6541
Practice Address - Fax:252-456-6541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health