Provider Demographics
NPI:1508040510
Name:CARR, LAWANA RISHAY (BA)
Entity Type:Individual
Prefix:
First Name:LAWANA
Middle Name:RISHAY
Last Name:CARR
Suffix:
Gender:F
Credentials:BA
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 1075
Mailing Address - Street 2:4114 SMISER ROAD
Mailing Address - City:CALERA
Mailing Address - State:OK
Mailing Address - Zip Code:74730-1075
Mailing Address - Country:US
Mailing Address - Phone:903-821-0060
Mailing Address - Fax:580-223-6306
Practice Address - Street 1:2530 S. COMMERCE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-0000
Practice Address - Country:US
Practice Address - Phone:580-223-5636
Practice Address - Fax:580-226-6727
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health