Healthcare Provider Details

I. General information

NPI: 1740868884
Provider Name (Legal Business Name): LOGAN LAWING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E MAIN ST
LINCOLNTON NC
28092-3449
US

IV. Provider business mailing address

169 LAKEWOOD AVE
LINCOLNTON NC
28092-7946
US

V. Phone/Fax

Practice location:
  • Phone: 704-748-0616
  • Fax: 704-240-9980
Mailing address:
  • Phone: 828-578-9525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2279
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: