Healthcare Provider Details

I. General information

NPI: 1164330213
Provider Name (Legal Business Name): SIMONE CHERELLE LAWRENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

946 W ANDREWS AVE STE R
HENDERSON NC
27536-2500
US

IV. Provider business mailing address

250 E RALEIGH BLVD
ROCKY MOUNT NC
27801-5695
US

V. Phone/Fax

Practice location:
  • Phone: 252-598-2462
  • Fax:
Mailing address:
  • Phone: 919-723-4908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP024452
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: