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General NPI Number Information
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NPI Number | 1023539285
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Entity Type | Organization
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Legal Business Name | LAWRENCE A. ELLSWORTH, LCSW, PLLC
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 8520 SIX FORKS RD STE 104
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City | RALEIGH
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State | NC
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Zip | 27615-3096
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Country | US
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Telephone | 919-815-4984
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Fax |
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Provider Business Mailing Address
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Address Line | 5104 BRIDGET DR
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City | RALEIGH
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State | NC
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Zip | 27603-9332
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Country | US
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Telephone | 919-815-4984
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MR. LAWRENCE A. ELLSWORTH
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Credential | LCSW
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Telephone | 919-815-4984
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C001070
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License Number State | NC
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