Provider Demographics
NPI:1356900849
Name:JACOB LAWRENCE
Entity type:Organization
Organization Name:JACOB LAWRENCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED INDIVIDUAL
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAS PLLC
Authorized Official - Phone:828-458-9445
Mailing Address - Street 1:19 EPLEE LN
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-6403
Mailing Address - Country:US
Mailing Address - Phone:828-458-9445
Mailing Address - Fax:828-544-1201
Practice Address - Street 1:19 EPLEE LN
Practice Address - Street 2:
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715-6403
Practice Address - Country:US
Practice Address - Phone:828-458-9445
Practice Address - Fax:828-544-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty