Basic Information
| Provider Information | |||||||||
| NPI: | 1023176781 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEAVES | ||||||||
| FirstName: | ROSA | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | LPA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 840 MOORE RD | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286438855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287575685 | ||||||||
| FaxNumber: | 8286954256 | ||||||||
| Practice Location | |||||||||
| Address1: | 2415A MORGANTON BLVD SW | ||||||||
| Address2: | |||||||||
| City: | LENOIR | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286459691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287575685 | ||||||||
| FaxNumber: | 8286954256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TB0200X | 1374 | NC | Y | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
ID Information
| ID | Type | State | Issuer | Description | 6107483 | 05 | NC | MEDICAID |