Healthcare Provider Details

I. General information

NPI: 1114552007
Provider Name (Legal Business Name): CORRIN MCKENNA LAWTER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6583 BOB WHITE TRL
STANLEY NC
28164-9797
US

IV. Provider business mailing address

716 MARSH RD
CHARLOTTE NC
28209-1851
US

V. Phone/Fax

Practice location:
  • Phone: 704-703-8588
  • Fax:
Mailing address:
  • Phone: 704-522-9912
  • Fax: 704-566-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-64692
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: