Provider Demographics
NPI:1922843341
Name:PRISM LITE
Entity type:Organization
Organization Name:PRISM LITE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIMNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-282-5358
Mailing Address - Street 1:7804C FAIRVIEW RD STE 241
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-4945
Mailing Address - Country:US
Mailing Address - Phone:808-282-5358
Mailing Address - Fax:
Practice Address - Street 1:301 OLD BELL RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-2793
Practice Address - Country:US
Practice Address - Phone:808-282-5358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)