Healthcare Provider Details

I. General information

NPI: 1679297311
Provider Name (Legal Business Name): JAMES LAWRENCE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 BROADWAY DR
HATTIESBURG MS
39401-5074
US

IV. Provider business mailing address

87 WOODVILLE TRCE
HATTIESBURG MS
39402-8347
US

V. Phone/Fax

Practice location:
  • Phone: 228-447-5265
  • Fax:
Mailing address:
  • Phone: 228-447-5265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4939
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12145
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: