Provider Demographics
NPI:1689326829
Name:LANCASTER, JALISHA
Entity type:Individual
Prefix:
First Name:JALISHA
Middle Name:
Last Name:LANCASTER
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 1:2676 SPARROW HILL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-5545
Mailing Address - Country:US
Mailing Address - Phone:330-858-5997
Mailing Address - Fax:
Practice Address - Street 1:665 E DUBLIN GRANVILLE RD STE 420
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3245
Practice Address - Country:US
Practice Address - Phone:614-914-8687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health