Provider Demographics
NPI:1154695047
Name:LAWRENCE, PAULA L (CRC, LCPC, CADC)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:L
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:CRC, LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-1808
Mailing Address - Country:US
Mailing Address - Phone:618-505-0784
Mailing Address - Fax:618-505-0785
Practice Address - Street 1:303 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:IL
Practice Address - Zip Code:62294-1808
Practice Address - Country:US
Practice Address - Phone:618-505-0784
Practice Address - Fax:618-505-0785
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180012544101YA0400X
IL00275446225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL00275446OtherCOMMISSION ON REHABILITATION COUNSELOR CERTIFICATION
IL271000235OtherSTATE LICENSE
IL180012544OtherSTATE LICENSE
IL272000224OtherSTATE LICENSE