Provider Demographics
NPI:1487991832
Name:LAWRENCE, VIOLA DELOIS II (MS, CAC-I)
Entity type:Individual
Prefix:
First Name:VIOLA
Middle Name:DELOIS
Last Name:LAWRENCE
Suffix:II
Gender:F
Credentials:MS, CAC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 RACEPATH AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29527-5453
Mailing Address - Country:US
Mailing Address - Phone:843-457-5553
Mailing Address - Fax:
Practice Address - Street 1:1908 RACEPATH AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29527-5453
Practice Address - Country:US
Practice Address - Phone:843-457-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1104017101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1104017Medicaid