Healthcare Provider Details

I. General information

NPI: 1285891077
Provider Name (Legal Business Name): JUDY DIANE LAWSON FUNGAROLI MAED, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1832 MOUNT OLIVET CHURCH RD
LEXINGTON NC
27295-9229
US

IV. Provider business mailing address

1832 MOUNT OLIVET CHURCH RD
LEXINGTON NC
27295-9229
US

V. Phone/Fax

Practice location:
  • Phone: 336-764-9620
  • Fax:
Mailing address:
  • Phone: 336-764-9620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3061
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: