Provider Demographics
NPI:1093772345
Name:WHITE, LAWRENCE HAWFIELD (MED,LADC, LCMHC)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:HAWFIELD
Last Name:WHITE
Suffix:
Gender:M
Credentials:MED,LADC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS BAY
Mailing Address - State:VT
Mailing Address - Zip Code:05481-0203
Mailing Address - Country:US
Mailing Address - Phone:802-238-2962
Mailing Address - Fax:802-524-1465
Practice Address - Street 1:725 MAQUAM SHORE RD
Practice Address - Street 2:
Practice Address - City:SWANTON
Practice Address - State:VT
Practice Address - Zip Code:05488-8437
Practice Address - Country:US
Practice Address - Phone:802-238-2962
Practice Address - Fax:802-524-1465
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000264101YA0400X
VT068-0000469101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT093553OtherVALUOPTIONS'
VT29138OtherBCBS
VT350650OtherMVP
VT1007029Medicaid
VT2025493OtherCIGNA