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: N

II. Dates (important events)

Enumeration Date: 02/24/2012
Last Update Date: 12/21/2024
Certification Date: 12/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S MAIN ST
TROY IL
62294-1808
US

IV. Provider business mailing address

303 S MAIN ST
TROY IL
62294-1808
US

V. Phone/Fax

Practice location:
  • Phone: 618-505-0784
  • Fax: 618-505-0785
Mailing address:
  • Phone: 618-505-0784
  • Fax: 618-505-0785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number180012544
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00275446
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: