Healthcare Provider Details

I. General information

NPI: 1982942900
Provider Name (Legal Business Name): MELANIE LAWSON LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE CRYSTAL O'CONNOR

II. Dates (important events)

Enumeration Date: 01/25/2013
Last Update Date: 09/02/2024
Certification Date: 09/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5209 W WENDOVER AVE
HIGH POINT NC
27265-9177
US

IV. Provider business mailing address

284 EXECUTIVE PARK DR STE 100
CONCORD NC
28025-1833
US

V. Phone/Fax

Practice location:
  • Phone: 368-891-5503
  • Fax:
Mailing address:
  • Phone: 704-939-1100
  • Fax: 704-939-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-3172
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: