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General NPI Number Information
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NPI Number | 1346708658
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Entity Type | Individual
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Provider Name | LAWRENCE CLARK LCMHC, LCASA, LPC
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Gender | Male
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Dates
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Enumeration Date | 03/05/2019
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 9625 DAVID TAYLOR DR
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City | CHARLOTTE
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State | NC
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Zip | 28262-2362
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Country | US
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Telephone | 704-387-8591
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Fax |
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Provider Business Mailing Address
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Address Line | 13814 HOLGATE HILL DR
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City | MINT HILL
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State | NC
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Zip | 28227-7507
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Country | US
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Telephone | 704-387-8591
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 14680
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCAS25210
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License Number State | NC
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