Provider Demographics
NPI:1437390077
Name:LEE HASTY, LCSW, PA
Entity Type:Organization
Organization Name:LEE HASTY, LCSW, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:MCNAIR
Authorized Official - Last Name:HASTY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:704-283-2900
Mailing Address - Street 1:2649 BREKONRIDGE CENTRE DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-5631
Mailing Address - Country:US
Mailing Address - Phone:704-283-2900
Mailing Address - Fax:704-283-2977
Practice Address - Street 1:2649 BREKONRIDGE CENTRE DR
Practice Address - Street 2:SUITE 112
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-5631
Practice Address - Country:US
Practice Address - Phone:704-283-2900
Practice Address - Fax:704-283-2977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOOO4881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002308Medicaid
NC6002308Medicaid