Healthcare Provider Details

I. General information

NPI: 1417245770
Provider Name (Legal Business Name): LAWRENCE MICHAEL CAMERON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 GLENDALE ST
DETROIT MI
48238-3333
US

IV. Provider business mailing address

3210 GLENDALE ST
DETROIT MI
48238-3333
US

V. Phone/Fax

Practice location:
  • Phone: 734-652-1471
  • Fax:
Mailing address:
  • Phone: 734-652-1471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401002606
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberTPMC8334
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9687
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC8901
License Number StateME
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMHC.LH.70136092
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2608686
License Number StateOH
# 7
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401002606
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: