Provider Demographics
NPI:1265206197
Name:LASSITER, JAMIE DENISE (CDCA)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:DENISE
Last Name:LASSITER
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:DENISE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDCA
Mailing Address - Street 1:3445 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COVENTRY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44319-3028
Mailing Address - Country:US
Mailing Address - Phone:330-644-4095
Mailing Address - Fax:
Practice Address - Street 1:3445 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COVENTRY TWP
Practice Address - State:OH
Practice Address - Zip Code:44319-3028
Practice Address - Country:US
Practice Address - Phone:330-644-4095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA185708101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)