Provider Demographics
NPI:1780377945
Name:LASSITER, RENEE BABETTE
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:BABETTE
Last Name:LASSITER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:BABETTE
Other - Last Name:LASSITER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1816 SILVERIA ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-1760
Mailing Address - Country:US
Mailing Address - Phone:757-470-8363
Mailing Address - Fax:757-937-9309
Practice Address - Street 1:1816 SILVERIA ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-1760
Practice Address - Country:US
Practice Address - Phone:757-470-8363
Practice Address - Fax:757-937-9309
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services