Provider Demographics
NPI:1699317040
Name:WITTE, LAWRENCE HAROLD (MS)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:HAROLD
Last Name:WITTE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 DEVONSHIRE DR STE 115
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-6076
Mailing Address - Country:US
Mailing Address - Phone:706-576-6575
Mailing Address - Fax:
Practice Address - Street 1:2013 DEVONSHIRE DR STE 115
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6076
Practice Address - Country:US
Practice Address - Phone:706-576-6575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011207101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor