Provider Demographics
NPI:1679323505
Name:RAINEY, LAZELMA ANITA
Entity type:Individual
Prefix:
First Name:LAZELMA
Middle Name:ANITA
Last Name:RAINEY
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 1:422 S CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4545
Mailing Address - Country:US
Mailing Address - Phone:980-888-2266
Mailing Address - Fax:
Practice Address - Street 1:422 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4545
Practice Address - Country:US
Practice Address - Phone:980-888-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician