Healthcare Provider Details

I. General information

NPI: 1841723376
Provider Name (Legal Business Name): MR. LEMUEL EMMITT RAWLS II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7676 HARVEST DR
SUFFOLK VA
23437-9363
US

IV. Provider business mailing address

7676 HARVEST DR
SUFFOLK VA
23437-9363
US

V. Phone/Fax

Practice location:
  • Phone: 704-778-1269
  • Fax:
Mailing address:
  • Phone: 704-778-1269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA12886
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number070104479
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: