Healthcare Provider Details

I. General information

NPI: 1366966244
Provider Name (Legal Business Name): LASONYA WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 CAPITOL AVE STE 415 #743781
CHEYENNE WY
82001-4562
US

IV. Provider business mailing address

PO BOX 2025
CONCORD NC
28026-2025
US

V. Phone/Fax

Practice location:
  • Phone: 888-664-3253
  • Fax:
Mailing address:
  • Phone: 888-664-3253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHL0601199
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMHL0601199
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHC3291
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: