Provider Demographics
NPI:1952430373
Name:KINCADE, LAWRENCE EDWARD (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:EDWARD
Last Name:KINCADE
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4201 LAKE BOONE TRL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7512
Mailing Address - Country:US
Mailing Address - Phone:919-233-1829
Mailing Address - Fax:919-785-0038
Practice Address - Street 1:4201 LAKE BOONE TRL
Practice Address - Street 2:SUITE 201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7512
Practice Address - Country:US
Practice Address - Phone:919-233-1829
Practice Address - Fax:919-785-0038
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0032261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical