Provider Information for 1154695047
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PAULA L LAWRENCE CRC, LCPC, CADC
Sex: Female
NPI: 1154695047
Last Updated: 2024-12-21
Certification Date: 2024-12-21
Certification Date: 2024-12-21
Details
Name | Value | ||||||||||||||||||||
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NPI | 1154695047 | ||||||||||||||||||||
Enumeration Date | 2012-02-24 | ||||||||||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||||||||||
Sole Proprietor | NO | ||||||||||||||||||||
Status | Active | ||||||||||||||||||||
Mailing Address | 303 S MAIN ST TROY, IL 62294-1808 United States Phone: 618-505-0784 | Fax:618-505-0785 | ||||||||||||||||||||
Primary Practice Address | 303 S MAIN ST TROY, IL 62294-1808 United States Phone: 618-505-0784 | Fax:618-505-0785 | ||||||||||||||||||||
Secondary Practice Address(es) | 123 S 10TH ST STE 502 208 N MARKET ST UNIT 1 | ||||||||||||||||||||
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