Provider Demographics
NPI:1871867580
Name:LAWHORN, LESLIE P (CSAC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:P
Last Name:LAWHORN
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
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Mailing Address - Street 1:60 COMMERCE PLZ
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7386
Mailing Address - Country:US
Mailing Address - Phone:910-521-2900
Mailing Address - Fax:910-775-9165
Practice Address - Street 1:109 CAMBRIDGE PL
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4717
Practice Address - Country:US
Practice Address - Phone:919-989-8114
Practice Address - Fax:919-938-0503
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2052101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2052OtherN C SUBSTANCE ABUSE PROFESSIONAL PRACTICE BOARD