| Organization Name: | LAKESIDE CENTER |
| NPI Number: | 1043697832 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LINDA LEITCH-ALFORD (OWNER) |
| Mailing Address: | 6515 George Washington Mem Hwy # 101 Yorktown |
| State: | VA US |
| Postal Code: | 236922182 |
| Phone Number: | 7577141838 |
| Fax Number: | 7573216269 |
| NPI Enumeration Date: | 04/30/2015 |
| NPI Last Update Date: | 04/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |