Provider Demographics
NPI:1720107535
Name:LAWRENCE, ALICIA MARIE (LSCSW)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 KENTUCKY ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2823
Mailing Address - Country:US
Mailing Address - Phone:785-393-2566
Mailing Address - Fax:785-371-1235
Practice Address - Street 1:901 KENTUCKY ST STE 306
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2858
Practice Address - Country:US
Practice Address - Phone:785-393-2566
Practice Address - Fax:785-371-1235
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS65291041C0700X, 104100000X
KS42951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200439170CMedicaid