Provider Demographics
NPI:1508034208
Name:LAWRENCE, KIPP R (LMHC)
Entity Type:Individual
Prefix:
First Name:KIPP
Middle Name:R
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 CUMBERLAND STREET SUITE 102
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895
Mailing Address - Country:US
Mailing Address - Phone:401-356-1940
Mailing Address - Fax:
Practice Address - Street 1:68 CUMBERLAND ST
Practice Address - Street 2:SUITE 102
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3300
Practice Address - Country:US
Practice Address - Phone:401-356-1940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI167101Y00000X
RIMHC00446101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI167OtherCOUNSELOR
RIKL69638Medicaid