Provider Demographics
NPI:1578006771
Name:SMITH, LAWRENCE JR (LICDC, LSW)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:LICDC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4194 S RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OH
Mailing Address - Zip Code:44081-9648
Mailing Address - Country:US
Mailing Address - Phone:440-259-8253
Mailing Address - Fax:440-259-8254
Practice Address - Street 1:4194 S RIDGE RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OH
Practice Address - Zip Code:44081-9648
Practice Address - Country:US
Practice Address - Phone:440-259-8253
Practice Address - Fax:440-259-8254
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.923267101YA0400X
OHS.14506041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical