Healthcare Provider Details

I. General information

NPI: 1154695047
Provider Name (Legal Business Name): PAULA L LAWRENCE CRC, LCPC, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2012
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 BROADWAY ST
MOUNT VERNON IL
62864-4009
US

IV. Provider business mailing address

1011 BROADWAY ST
MOUNT VERNON IL
62864-4009
US

V. Phone/Fax

Practice location:
  • Phone: 618-816-5158
  • Fax:
Mailing address:
  • Phone: 618-816-5158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00275446
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number180012544
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: