Provider Demographics
NPI:1801908678
Name:LAWRENCE, DWAYNE THOMAS (LCMHC, LCAS)
Entity type:Individual
Prefix:
First Name:DWAYNE
Middle Name:THOMAS
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:LCMHC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 PALADIN DR APT D
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7745
Mailing Address - Country:US
Mailing Address - Phone:252-341-3192
Mailing Address - Fax:
Practice Address - Street 1:413 PALADIN DR APT D
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7745
Practice Address - Country:US
Practice Address - Phone:252-341-3192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NC7328101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111884Medicaid