MEDICARE: LSJ RESILIENCE PROJECT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	251S00000X	Community/Behavioral Health Agency
3	261QM1300X	Multi-Specialty Clinic/Center
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
5	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
6	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1548023930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LSJ RESILIENCE PROJECT

Provider Business Mailing Address
First Line	:	1905 J N PEASE PL STE 103
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4509
Country	:	US
Telephone Number	:	704-671-2172
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 J N PEASE PL STE 103
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4509
Country	:	US
Telephone Number	:	704-910-0136
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAKESHA SHINGLER HOWELL
Credential	:
Telephone Number	:	704-671-2172

Provider Enumeration Date	:	01/30/2024
Last Update Date	:	06/09/2026

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