Individual
DR. LAUREN KAVANAUGH-WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
18805 W CATAWBA AVE, STE 207, CORNELIUS, NC 28031-4608
(704) 787-4272
(980) 321-7106
Mailing address
18805 W CATAWBA AVE STE 207, PO BOX 361, CORNELIUS, NC 28031-4609
(704) 787-4272
(980) 321-7106
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
630101257
MI
103T00000X
Psychologist
Primary
P-3786
NC
103TC0700X
Clinical Psychologist
071005134
IL
103TC0700X
Clinical Psychologist
6301011257
MI
Other
Enumeration date
10/30/2007
Last updated
01/13/2012
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