Provider Demographics
NPI:1912249863
Name:MCDOWELL, LASHERA (CBHT)
Entity Type:Individual
Prefix:
First Name:LASHERA
Middle Name:
Last Name:MCDOWELL
Suffix:
Gender:F
Credentials:CBHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:882 GLADIOLA CIR APT 362
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-6259
Mailing Address - Country:US
Mailing Address - Phone:321-452-0800
Mailing Address - Fax:
Practice Address - Street 1:1407 DIXON BLVD
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-6411
Practice Address - Country:US
Practice Address - Phone:321-452-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5023172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker