Provider Demographics
NPI:1346484284
Name:VISIONONE HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:VISIONONE HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:B
Authorized Official - Last Name:LASSITER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MS
Authorized Official - Phone:704-414-6500
Mailing Address - Street 1:6047 TYVOLA GLEN CIR STE 241
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-6436
Mailing Address - Country:US
Mailing Address - Phone:704-414-6550
Mailing Address - Fax:
Practice Address - Street 1:6047 TYVOLA GLEN CIR STE 241
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-6436
Practice Address - Country:US
Practice Address - Phone:704-414-6550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1131103TH0100X
NCC0054041041C0700X
NC201762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6113034Medicaid