Provider Demographics
NPI:1467668137
Name:LAWRENSON, CHARLES E JR (MS)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:E
Last Name:LAWRENSON
Suffix:JR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60250 SOUTHGATE RD
Mailing Address - Street 2:
Mailing Address - City:BYESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43723-9549
Mailing Address - Country:US
Mailing Address - Phone:740-685-2524
Mailing Address - Fax:
Practice Address - Street 1:60330 SOUTHGATE RD
Practice Address - Street 2:
Practice Address - City:BYESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43723-9549
Practice Address - Country:US
Practice Address - Phone:740-685-2591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF.0000084106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist