Provider Demographics
NPI:1346803459
Name:LAWRENCE, SHIRLEY JEAN (CADC)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:JEAN
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:JEAN
Other - Last Name:TALBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:619 SULLIVAN RD
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3437
Mailing Address - Country:US
Mailing Address - Phone:704-871-0934
Mailing Address - Fax:704-402-1065
Practice Address - Street 1:619 SULLIVAN RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3437
Practice Address - Country:US
Practice Address - Phone:704-871-0934
Practice Address - Fax:704-402-1065
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCADC-20954101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)