Provider Demographics
NPI:1710487111
Name:LASSITER, DAVEDA
Entity Type:Individual
Prefix:
First Name:DAVEDA
Middle Name:
Last Name:LASSITER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9221 HAMPTON OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-3851
Mailing Address - Country:US
Mailing Address - Phone:301-851-9790
Mailing Address - Fax:
Practice Address - Street 1:9221 HAMPTON OVERLOOK
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-3851
Practice Address - Country:US
Practice Address - Phone:301-851-9790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty