Basic Information
Provider Information | |||||||||
NPI: | 1336103290 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LAWS | ||||||||
FirstName: | CHERYL | ||||||||
MiddleName: | DENISE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | CMSW NCACI LAAOAC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SNAPP | ||||||||
OtherFirstName: | CHERYL | ||||||||
OtherMiddleName: | DENISE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2817 REILLY RD | ||||||||
Address2: | WOMACK ARMY MEDICAL CENTER MEXC-COD CREDENTIALS | ||||||||
City: | FORT BRAGG | ||||||||
State: | NC | ||||||||
PostalCode: | 28310 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9109078922 | ||||||||
FaxNumber: | 9109076069 | ||||||||
Practice Location | |||||||||
Address1: | BASTOGNE & REILLY RD | ||||||||
Address2: | CLARK HEALTH CLINIC BLDG 5-4257 | ||||||||
City: | FT BRAGG | ||||||||
State: | NC | ||||||||
PostalCode: | 28310 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9109079652 | ||||||||
FaxNumber: | 9109078229 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/17/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | X | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LDC0000000298 | TN | Y |   | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.