Provider Demographics
NPI:1609582832
Name:LAGESSE, SAVANNAH SUMMER (LCMHCA)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:SUMMER
Last Name:LAGESSE
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 THUNDER VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-4853
Mailing Address - Country:US
Mailing Address - Phone:919-622-6890
Mailing Address - Fax:
Practice Address - Street 1:320 N JUDD PKWY NE STE 200
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2624
Practice Address - Country:US
Practice Address - Phone:919-557-8222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18518101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health