Provider Demographics
NPI:1285891077
Name:LAWSON FUNGAROLI, JUDY DIANE (MAED, LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:DIANE
Last Name:LAWSON FUNGAROLI
Suffix:
Gender:F
Credentials:MAED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 MOUNT OLIVET CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-9229
Mailing Address - Country:US
Mailing Address - Phone:336-764-9620
Mailing Address - Fax:
Practice Address - Street 1:1832 MOUNT OLIVET CHURCH RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-9229
Practice Address - Country:US
Practice Address - Phone:336-764-9620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3061101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health