Provider Demographics
NPI:1417464900
Name:ST LAZARUS BEHAVIORAL HEALTH PC
Entity Type:Organization
Organization Name:ST LAZARUS BEHAVIORAL HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEKETA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-624-5802
Mailing Address - Street 1:8401 MEDICAL PLAZA DR STE 355
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-9718
Mailing Address - Country:US
Mailing Address - Phone:877-624-5802
Mailing Address - Fax:888-974-1542
Practice Address - Street 1:8401 MEDICAL PLAZA DR STE 355
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-9718
Practice Address - Country:US
Practice Address - Phone:877-624-5802
Practice Address - Fax:888-974-1542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-05
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty