Healthcare Provider Details

I. General information

NPI: 1982423984
Provider Name (Legal Business Name): MADELEINE L LAWRENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 S ST NW STE 6B
WASHINGTON DC
20009-6107
US

IV. Provider business mailing address

1755 S ST NW STE 6B
WASHINGTON DC
20009-6107
US

V. Phone/Fax

Practice location:
  • Phone: 202-234-7738
  • Fax:
Mailing address:
  • Phone: 202-234-7738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGPC200001778
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: