Provider Demographics
NPI:1093004764
Name:LAWRENCE, DEVON JAY (LCSW)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:JAY
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 N LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3250
Mailing Address - Country:US
Mailing Address - Phone:571-839-2617
Mailing Address - Fax:
Practice Address - Street 1:2105 N LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3250
Practice Address - Country:US
Practice Address - Phone:571-839-2617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-178791041C0700X
VA09040120831041C0700X
MO2011004073104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker