Provider Demographics
NPI:1326776543
Name:MERAKI MENTAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:MERAKI MENTAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAMETRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LASSITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-941-9849
Mailing Address - Street 1:13203 N ENON CHURCH RD STE A151
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-3122
Mailing Address - Country:US
Mailing Address - Phone:804-667-6589
Mailing Address - Fax:
Practice Address - Street 1:13203 N ENON CHURCH RD STE A151
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-3122
Practice Address - Country:US
Practice Address - Phone:804-667-6589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health