Provider Demographics
NPI:1124724927
Name:CADWALLADER, LORRAINE DIANE (LPC)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:DIANE
Last Name:CADWALLADER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:D
Other - Last Name:CADWALLADER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1300 FULTON ST STE 402
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2661
Mailing Address - Country:US
Mailing Address - Phone:940-382-5328
Mailing Address - Fax:940-898-8527
Practice Address - Street 1:1300 FULTON ST STE 402
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2661
Practice Address - Country:US
Practice Address - Phone:940-382-5328
Practice Address - Fax:940-898-8527
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82196101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82196OtherLICENSED PROFESSIONAL COUNSELOR