MEDICARE: MS. LAKISHIA LAWON CHRISTIAN CHW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker	1815	NC

General Provider Information

NPI Number	:	1245173897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAKISHIA LAWON CHRISTIAN CHW

Provider Business Mailing Address
First Line	:	3320 DUNN COMMONS PKWY APT 310
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-6790
Country	:	US
Telephone Number	:	704-658-6607
Fax Number	:

Provider Business Practice Location Address
First Line	:	3320 DUNN COMMONS PKWY APT 310
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-6790
Country	:	US
Telephone Number	:	704-658-6607
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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