Provider Demographics
NPI:1881723310
Name:LAWRENCE, TERESA ELIZABETH (MDIV)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ELIZABETH
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5306
Mailing Address - Country:US
Mailing Address - Phone:910-484-0176
Mailing Address - Fax:910-484-5781
Practice Address - Street 1:114 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5306
Practice Address - Country:US
Practice Address - Phone:910-484-0176
Practice Address - Fax:910-484-5781
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC131CROtherBCBS
NC6105110Medicaid
NCA0123OtherMEDCOST