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General NPI Number Information
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NPI Number | 1194839308
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Entity Type | Individual
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Provider Name | LAWRENCE A. ELLSWORTH MSSW, LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 8520 SIX FORKS RD SUITE 104
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City | RALEIGH
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State | NC
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Zip | 27615-3095
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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 | 919-779-2964
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Fax | 919-212-7826
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | C001070
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License Number State | NC
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