Healthcare Provider Details

I. General information

NPI: 1831247352
Provider Name (Legal Business Name): LAURIE LANCASTER PATRICE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURIE PATRICE WELLS

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 LAWRENCEVILLE SUWANEE RD SUITE A
SUWANEE GA
30024-6425
US

IV. Provider business mailing address

3455 LAWRENCEVILLE SUWANEE RD SUITE A
SUWANEE GA
30024-6425
US

V. Phone/Fax

Practice location:
  • Phone: 770-634-3285
  • Fax: 404-201-2103
Mailing address:
  • Phone: 770-634-3285
  • Fax: 404-201-2103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3972
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: