Provider Demographics
NPI:1013208404
Name:LAWRENCE, AVIS D (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AVIS
Middle Name:D
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6486 HIGHWAY 44
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-8158
Mailing Address - Country:US
Mailing Address - Phone:225-910-2477
Mailing Address - Fax:225-647-3213
Practice Address - Street 1:17487 OLD JEFFERSON HWY STE A
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4043
Practice Address - Country:US
Practice Address - Phone:225-910-2477
Practice Address - Fax:225-647-3213
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA53291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1013208404Medicaid