Provider Information for 1760721252
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ANGELIQUE LAWRENCE LCMFT, CASAC
Sex: Female
NPI: 1760721252
Last Updated: 2020-08-22
Certification Date: 2020-08-22
Certification Date: 2020-08-22
Details
| Name | Value | ||||||||||||||||||||||||
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| NPI | 1760721252 | ||||||||||||||||||||||||
| Enumeration Date | 2013-02-05 | ||||||||||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||||||||||
| Status | Active | ||||||||||||||||||||||||
| Mailing Address | 9819 SUDLEY MANOR DR MANASSAS, VA 20109-6230 United States Phone: 917-680-2145 | Fax: | ||||||||||||||||||||||||
| Primary Practice Address | 9819 SUDLEY MANOR DR MANASSAS, VA 20109-6230 United States Phone: 917-680-2145 | Fax: | ||||||||||||||||||||||||
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