Provider Demographics
NPI:1295576460
Name:LANCASTER, SAFFRON BROOKE
Entity type:Individual
Prefix:
First Name:SAFFRON
Middle Name:BROOKE
Last Name:LANCASTER
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 1:3317 RENAISSANCE WAY NE APT 3317
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2464
Mailing Address - Country:US
Mailing Address - Phone:573-842-8445
Mailing Address - Fax:
Practice Address - Street 1:3317 RENAISSANCE WAY NE APT 3317
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2464
Practice Address - Country:US
Practice Address - Phone:573-842-8445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
GAAPC009881101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health