=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487844965
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE LAWSON'S HOUSE-WILMINGTON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2007
-----------------------------------------------------
Last Update Date | 07/31/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6622 GORDON RD
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28411-8414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-397-7685
-----------------------------------------------------
Fax | 910-397-7685
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 317
-----------------------------------------------------
City | HARRELLS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28444-0317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-397-7685
-----------------------------------------------------
Fax | 910-397-7686
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. SHARITA M LAWSON
-----------------------------------------------------
Credential | MS
-----------------------------------------------------
Telephone | 910-409-8476
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------