Provider Demographics
NPI:1780752949
Name:NOLLETTI, LAKSHMI REBECCA (LCSW, LISAC, SAP)
Entity type:Individual
Prefix:MS
First Name:LAKSHMI
Middle Name:REBECCA
Last Name:NOLLETTI
Suffix:
Gender:F
Credentials:LCSW, LISAC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67133
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85082-7133
Mailing Address - Country:US
Mailing Address - Phone:602-550-6240
Mailing Address - Fax:
Practice Address - Street 1:4250 E CAMELBACK RD
Practice Address - Street 2:SUITE K300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-8301
Practice Address - Country:US
Practice Address - Phone:602-343-8232
Practice Address - Fax:602-343-8233
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10865101YA0400X
AZICADC 18225101YA0400X
AZABCAC 1870101YA0400X
AZSAP101YP2500X
AZLCSW-111261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional