Healthcare Provider Details

I. General information

NPI: 1548023930
Provider Name (Legal Business Name): LSJ RESILIENCE PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 J N PEASE PL STE 103
CHARLOTTE NC
28262-4509
US

IV. Provider business mailing address

1905 J N PEASE PL STE 103
CHARLOTTE NC
28262-4509
US

V. Phone/Fax

Practice location:
  • Phone: 704-910-0136
  • Fax:
Mailing address:
  • Phone: 704-671-2172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAKESHA SHINGLER HOWELL
Title or Position: PRESIDENT
Credential:
Phone: 704-671-2172