Provider Demographics
NPI:1841963345
Name:FLEMING-WILLIAMS, LALITA MARIE
Entity type:Individual
Prefix:MRS
First Name:LALITA
Middle Name:MARIE
Last Name:FLEMING-WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LALITA
Other - Middle Name:MARIE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IRMA'S HOUSE LLC
Mailing Address - Street 1:900 WASHBURN AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-3556
Mailing Address - Country:US
Mailing Address - Phone:612-363-4454
Mailing Address - Fax:
Practice Address - Street 1:900 WASHBURN AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-3556
Practice Address - Country:US
Practice Address - Phone:612-363-4454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1108598171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator