Provider Demographics
NPI:1215815675
Name:DANIEL, LAWRENCE SR
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:DANIEL
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 SHORTRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-5767
Mailing Address - Country:US
Mailing Address - Phone:904-802-8082
Mailing Address - Fax:
Practice Address - Street 1:6639 SOUTHPOINT PKWY STE 108
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8042
Practice Address - Country:US
Practice Address - Phone:904-438-7640
Practice Address - Fax:904-438-7656
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)