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General NPI Number Information
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NPI Number | 1437603735
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Entity Type | Individual
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Provider Name | MISTY LAWRENCE
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Gender | Female
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Dates
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Enumeration Date | 08/04/2016
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 14636 REESE BLVD W
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-7946
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Country | US
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Telephone | 704-849-0144
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Fax |
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Provider Business Mailing Address
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Address Line | 2124 CROWN CENTRE DR STE 400
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City | CHARLOTTE
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State | NC
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Zip | 28227-7804
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Country | US
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Telephone | 704-849-0144
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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