Provider Demographics
NPI:1629346663
Name:LAWRENCE, STACEY A (LMSW)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:A
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5824 W XY AVE
Mailing Address - Street 2:
Mailing Address - City:SCHOOLCRAFT
Mailing Address - State:MI
Mailing Address - Zip Code:49087-9163
Mailing Address - Country:US
Mailing Address - Phone:269-532-4883
Mailing Address - Fax:
Practice Address - Street 1:5824 W XY AVE
Practice Address - Street 2:
Practice Address - City:SCHOOLCRAFT
Practice Address - State:MI
Practice Address - Zip Code:49087-9163
Practice Address - Country:US
Practice Address - Phone:269-532-4883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010931451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical