Provider Demographics
NPI:1942869722
Name:PRIMUS, LAWRENCE JAMEL SR
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:JAMEL
Last Name:PRIMUS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 AUBURN DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-9353
Mailing Address - Country:US
Mailing Address - Phone:910-922-3092
Mailing Address - Fax:
Practice Address - Street 1:2212 HOPE MILLS RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4228
Practice Address - Country:US
Practice Address - Phone:910-779-0454
Practice Address - Fax:910-491-0833
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0135161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical