MEDICARE: LASONYA WATSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MHL0601199	NC
2	172V00000X	Community Health Worker
3	175T00000X	Peer Specialist
4	103K00000X	Behavior Analyst
5	106E00000X	Assistant Behavior Analyst
6	101YA0400X	Addiction (Substance Use Disorder) Counselor	MHL0601199	NC
7	374U00000X	Home Health Aide	HC3291	NC

General Provider Information

NPI Number	:	1366966244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LASONYA WATSON

Provider Business Mailing Address
First Line	:	PO BOX 2025
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28026-2025
Country	:	US
Telephone Number	:	888-664-3253
Fax Number	:

Provider Business Practice Location Address
First Line	:	1603 CAPITOL AVE STE 415
Second Line	:	#743781
City	:	CHEYENNE
State	:	WY
Zip	:	82001-4562
Country	:	US
Telephone Number	:	888-664-3253
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2017
Last Update Date	:	03/27/2026

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