Provider Demographics
NPI:1992928303
Name:OLSON, LAWRENCE M (LPC, MAC, CDCI)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:M
Last Name:OLSON
Suffix:
Gender:M
Credentials:LPC, MAC, CDCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21008
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99802-1008
Mailing Address - Country:US
Mailing Address - Phone:907-321-5104
Mailing Address - Fax:
Practice Address - Street 1:9000 GLACIER HWY STE 204
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8097
Practice Address - Country:US
Practice Address - Phone:907-321-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2186101YA0400X
AK24101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional