Dr. Lauren Kavanaugh-Wallace, PsyD

Psychologist in Cornelius, NC. Individual provider (NPI-1).

NPI number1649459397

StatusActive

Last updated in NPPESJan 13, 2012

Details

NPI: 1649459397
Entity type: Individual (NPI-1)
Name: Dr. Lauren Kavanaugh-Wallace
Credential: PsyD
Sex: Female
Sole proprietor: Yes
Enumeration date: Oct 30, 2007
Last updated: Jan 13, 2012

Medicare and OIG

Medicare enrolled (PECOS): Not in the Medicare enrollment file
Can order and refer: Not on the CMS order and referring list
OIG exclusion list: This NPI is not listed

CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
103T00000X	Psychologist	P-3786	NC	Yes
103T00000X	Psychologist	630101257	MI
103TC0700X	Psychologist, Clinical	6301011257	MI
103TC0700X	Psychologist, Clinical	071005134	IL

Practice location

18805 W Catawba Ave
Ste 207
Cornelius, NC 28031-4608

Phone 704-787-4272 · Fax 980-321-7106

Mailing address

18805 W Catawba Ave Ste 207
Po Box 361
Cornelius, NC 28031-4609

Phone 704-787-4272 · Fax 980-321-7106

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Psychologist providers in Cornelius, NC

All 13 Psychologist providers in Cornelius · All 942 providers in Cornelius

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