Provider Demographics
NPI:1104977784
Name:LAWSON, GRETTA P (MED)
Entity type:Individual
Prefix:
First Name:GRETTA
Middle Name:P
Last Name:LAWSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WISETON CT
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-4545
Mailing Address - Country:US
Mailing Address - Phone:864-963-1570
Mailing Address - Fax:
Practice Address - Street 1:1200 WOODRUFF RD STE A3
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5732
Practice Address - Country:US
Practice Address - Phone:864-297-9999
Practice Address - Fax:864-288-7937
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1848101YP2500X
SC1849106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist