Provider Demographics
NPI:1508238809
Name:LAKELANDS NUTRITION COUNSELING LLC
Entity Type:Organization
Organization Name:LAKELANDS NUTRITION COUNSELING LLC
Other - Org Name:LAKELAND NUTRTION COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LDN
Authorized Official - Phone:864-992-6355
Mailing Address - Street 1:128 MAXWELL AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-2641
Mailing Address - Country:US
Mailing Address - Phone:864-992-6355
Mailing Address - Fax:
Practice Address - Street 1:128 MAXWELL AVE
Practice Address - Street 2:SUITE F
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2641
Practice Address - Country:US
Practice Address - Phone:864-992-6355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1150133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty