Provider Demographics
NPI:1790568582
Name:LAWRENCE, HEATHER KATHLEEN
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:KATHLEEN
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-0031
Mailing Address - Country:US
Mailing Address - Phone:541-704-3003
Mailing Address - Fax:541-812-8814
Practice Address - Street 1:310 NW 5TH ST STE 101
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4849
Practice Address - Country:US
Practice Address - Phone:541-286-4010
Practice Address - Fax:541-286-4011
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)