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General NPI Number Information
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NPI Number | 1255798351
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Entity Type | Individual
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Provider Name | LAZRIA PRICE
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Gender | Female
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Dates
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Enumeration Date | 01/20/2016
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Last Update Date | 05/04/2018
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Provider Practice Location Address
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Address Line | 3801 MONARCH DRIVE 2D
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City | RACINE
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State | WI
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Zip | 53406-5500
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Country | US
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Telephone | 262-833-7402
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Fax |
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Provider Business Mailing Address
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Address Line | 3801 MONARCH DRIVE 2D
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City | RACINE
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State | WI
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Zip | 53406-5500
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Country | US
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Telephone | 262-833-7402
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 16859
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3219
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License Number State | WI
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