Provider Demographics
NPI:1942258686
Name:LAWRENCE, VICKIE (LCSW)
Entity Type:Individual
Prefix:PROF
First Name:VICKIE
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 W MARKHAM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3412
Mailing Address - Country:US
Mailing Address - Phone:501-614-7388
Mailing Address - Fax:501-614-7349
Practice Address - Street 1:5520 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3412
Practice Address - Country:US
Practice Address - Phone:501-614-7388
Practice Address - Fax:501-614-7349
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1653-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5W765Medicare ID - Type UnspecifiedLCSW