Provider Demographics
NPI:1508643495
Name:LAWRENCE, BYRON SCOTT (MS, NCC)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:SCOTT
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2376 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4492
Mailing Address - Country:US
Mailing Address - Phone:470-798-4734
Mailing Address - Fax:
Practice Address - Street 1:2376 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4492
Practice Address - Country:US
Practice Address - Phone:470-798-4734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health