MEDICARE: DOUGLAS M LAWRENCE CDP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	60866603	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750852869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS M LAWRENCE CDP

Provider Business Mailing Address
First Line	:	614 DIVISION ST # 19
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-4614
Country	:	US
Telephone Number	:	360-337-4625
Fax Number	:	360-337-4704

Provider Business Practice Location Address
First Line	:	614 DIVISION ST # 19
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-4614
Country	:	US
Telephone Number	:	360-337-4625
Fax Number	:	360-337-4704

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2018
Last Update Date	:	12/16/2018

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Directions to “ DOUGLAS M LAWRENCE CDP” Practice Location

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