Healthcare Provider Details

I. General information

NPI: 1952430373
Provider Name (Legal Business Name): LAWRENCE EDWARD KINCADE PH.D., LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 LAKE BOONE TRL SUITE 201
RALEIGH NC
27607-7512
US

IV. Provider business mailing address

4201 LAKE BOONE TRL SUITE 201
RALEIGH NC
27607-7512
US

V. Phone/Fax

Practice location:
  • Phone: 919-233-1829
  • Fax: 919-785-0038
Mailing address:
  • Phone: 919-233-1829
  • Fax: 919-785-0038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC003226
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: