Healthcare Provider Details

I. General information

NPI: 1326469636
Provider Name (Legal Business Name): JAMIKA I LAWSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2014
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44625 18TH ST W
LANCASTER CA
93534-2709
US

IV. Provider business mailing address

44625 18TH ST W
LANCASTER CA
93534-2709
US

V. Phone/Fax

Practice location:
  • Phone: 661-675-7017
  • Fax:
Mailing address:
  • Phone: 661-675-7017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: