Provider Demographics
NPI:1760633002
Name:WAXMAN, LAWRENCE TODD (LPC)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:TODD
Last Name:WAXMAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 TRAPPERS RUN DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-4833
Mailing Address - Country:US
Mailing Address - Phone:847-421-0778
Mailing Address - Fax:
Practice Address - Street 1:410 TRAPPERS RUN DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-4833
Practice Address - Country:US
Practice Address - Phone:847-421-0778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9373101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health