Provider Demographics
NPI:1598112179
Name:WHITAKER, LAWRENCE (MA;LPC)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:MA;LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35555 KENAI SPUR HWY # 458
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7674
Mailing Address - Country:US
Mailing Address - Phone:907-545-7059
Mailing Address - Fax:907-260-4063
Practice Address - Street 1:245 N BINKLEY ST STE 202
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7500
Practice Address - Country:US
Practice Address - Phone:907-714-4521
Practice Address - Fax:907-260-4063
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK106271101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional