Healthcare Provider Details

I. General information

NPI: 1750227427
Provider Name (Legal Business Name): JARED AVERY LAWSON LCSWE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18C E MAIN ST
SALEM VA
24153-3807
US

IV. Provider business mailing address

5235 COLONIAL DR
DUBLIN VA
24084-3508
US

V. Phone/Fax

Practice location:
  • Phone: 540-818-9989
  • Fax:
Mailing address:
  • Phone: 540-818-9989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: