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General NPI Number Information
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NPI Number | 1801571039
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Entity Type | Individual
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Provider Name | LAWRENCE SIDBURY JR.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 6946 FOREST HILL AVE
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City | RICHMOND
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State | VA
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Zip | 23225-1606
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Country | US
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Telephone | 804-482-0274
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Fax |
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Provider Business Mailing Address
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Address Line | 10575 BENT TREE VW
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City | JOHNS CREEK
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State | GA
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Zip | 30097-5988
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 8248-07-006
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License Number State | VA
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