Provider Demographics
NPI:1811676133
Name:LASSITER, STARLISA
Entity type:Individual
Prefix:
First Name:STARLISA
Middle Name:
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 1:140 PRESTON EXECUTIVE DR STE A
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8488
Mailing Address - Country:US
Mailing Address - Phone:919-521-0665
Mailing Address - Fax:919-882-9260
Practice Address - Street 1:100 CONNEMARA DR STE 105
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-5889
Practice Address - Country:US
Practice Address - Phone:919-521-0665
Practice Address - Fax:919-882-9260
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0192421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical