Provider Demographics
NPI:1285859983
Name:LORENCE, JEFFREY MATTHEW (M,A, LPA)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:MATTHEW
Last Name:LORENCE
Suffix:
Gender:M
Credentials:M,A, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 RANDOLPH RD STE 328
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2378
Mailing Address - Country:US
Mailing Address - Phone:704-364-9024
Mailing Address - Fax:
Practice Address - Street 1:4425 RANDOLPH ROAD - SUITE# 328
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2378
Practice Address - Country:US
Practice Address - Phone:704-364-9024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1983103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical