Provider Demographics
NPI:1265165625
Name:LASSITER, ALICIA MICHELLE
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MICHELLE
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 1:1319 N BRIGHTLEAF BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4876
Mailing Address - Country:US
Mailing Address - Phone:919-934-1080
Mailing Address - Fax:919-934-1319
Practice Address - Street 1:1319 N BRIGHTLEAF BLVD STE F
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4876
Practice Address - Country:US
Practice Address - Phone:919-934-1312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28146101YA0400X
NCP0178831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)