Provider Demographics
NPI:1902634108
Name:JOHNSON, LAWRENCE LESTER II
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:LESTER
Last Name:JOHNSON
Suffix:II
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 1:253 CHANDLERS GLEN DR
Mailing Address - Street 2:
Mailing Address - City:BUNKER HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25413-2128
Mailing Address - Country:US
Mailing Address - Phone:540-664-0328
Mailing Address - Fax:
Practice Address - Street 1:253 CHANDLERS GLEN DR
Practice Address - Street 2:
Practice Address - City:BUNKER HILL
Practice Address - State:WV
Practice Address - Zip Code:25413-2128
Practice Address - Country:US
Practice Address - Phone:540-664-0328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health