Provider Demographics
NPI:1508560251
Name:LAWSON, ANGELIQUE RAFFINEE (PMHNP)
Entity type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:RAFFINEE
Last Name:LAWSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 BROAD ST FL 1
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-1214
Mailing Address - Country:US
Mailing Address - Phone:802-239-6065
Mailing Address - Fax:855-780-0882
Practice Address - Street 1:823 BROAD ST FL 1
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1214
Practice Address - Country:US
Practice Address - Phone:802-239-6065
Practice Address - Fax:855-780-0882
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN244589363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health