Provider Demographics
NPI:1023176781
Name:NEAVES, ROSA LEE (LPA)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:LEE
Last Name:NEAVES
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 MOORE RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:NC
Mailing Address - Zip Code:28643-8855
Mailing Address - Country:US
Mailing Address - Phone:828-757-5685
Mailing Address - Fax:828-695-4256
Practice Address - Street 1:2415A MORGANTON BLVD SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-9691
Practice Address - Country:US
Practice Address - Phone:828-757-5685
Practice Address - Fax:828-695-4256
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1374103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107483Medicaid