Basic Information
| Provider Information | |||||||||
| NPI: | 1245675370 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LASHER | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 WATER OAK DR | ||||||||
| Address2: | |||||||||
| City: | CEDARTOWN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301252095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707482225 | ||||||||
| FaxNumber: | 7707490939 | ||||||||
| Practice Location | |||||||||
| Address1: | 180 WATER OAK DR | ||||||||
| Address2: | |||||||||
| City: | CEDARTOWN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301252095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707482225 | ||||||||
| FaxNumber: | 7707490939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2013 | ||||||||
| LastUpdateDate: | 11/21/2016 | ||||||||
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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 | 104100000X | MSW006066 | GA | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | CSW005558 | GA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.