Provider Demographics
NPI:1619744000
Name:STRANGE, DEIRDRE (LCAS-A)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:
Last Name:STRANGE
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 N LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3898
Mailing Address - Country:US
Mailing Address - Phone:704-830-4125
Mailing Address - Fax:
Practice Address - Street 1:804 N LAFAYETTE ST STE 2
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3898
Practice Address - Country:US
Practice Address - Phone:704-476-4106
Practice Address - Fax:704-481-7581
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-24786101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty