Healthcare Provider Details

I. General information

NPI: 1629048863
Provider Name (Legal Business Name): ADEWALE LARRY LAWAL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 N POST OAK RD STE 100
HOUSTON TX
77055-7236
US

IV. Provider business mailing address

101 FEU FOLLET RD STE 100
LAFAYETTE LA
70508-4234
US

V. Phone/Fax

Practice location:
  • Phone: 713-686-9194
  • Fax: 713-686-9413
Mailing address:
  • Phone: 713-686-9194
  • Fax: 713-686-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS10779
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: