Healthcare Provider Details

I. General information

NPI: 1801856265
Provider Name (Legal Business Name): MONICA HAUCK LAVERY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 YONKERS RD
RALEIGH NC
27604-2258
US

IV. Provider business mailing address

5205 COFFEE TREE DR
RALEIGH NC
27613-4553
US

V. Phone/Fax

Practice location:
  • Phone: 919-791-5346
  • Fax: 919-782-8731
Mailing address:
  • Phone: 919-791-5346
  • Fax: 919-782-8731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC002691
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: