Provider Demographics
NPI:1760721252
Name:LAWRENCE, ANGELIQUE (LCMFT, CASAC)
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LCMFT, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9819 SUDLEY MANOR DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-6230
Mailing Address - Country:US
Mailing Address - Phone:917-680-2145
Mailing Address - Fax:
Practice Address - Street 1:9819 SUDLEY MANOR DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-6230
Practice Address - Country:US
Practice Address - Phone:917-680-2145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 103T00000X
NY23079101YA0400X
NY000059106H00000X
VA0717001324106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist